































TREASURY DEPARTMENT 

UNITED STATES PUBLIC HEALTH SERVICE 


MISCELLANEOUS PUBLICATION No. 17 


PREVENTION OF DISEASE 
AND CARE OF THE SICK 

HOW TO KEEP WELL AND WHAT 
TO DO IN CASE OF SUDDEN ILLNESS 


BY 

W. G. STIMPSON, M. D. 

Assistant Surgeon General, Untied States Public Health Service 


INCLUDING 

FIRST AID TO THE INJURED 

BY 

M. H. FOSTER, A. M., M. D. 

Surgeon, United States Public Health Service 


Fourth Edition 


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WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1923 




































"K A if 



This edition was prepared especially for the information of 
soldiers , sailors , marines , nurses discharged from military duty , 
is designed to help those who are ill to regain health and strength 
and to stimulate the interest in public health matters , awakened 

during their service with the military forces. 

2 


library of congress 
aiccivco 

MOV 1 9 1923 




DOCUMENTS DIVISION 






moA n/ So /iS 


TABLE OF CONTEXTS. 


Prevention of disease. 

Introduction. 

Sanitation of buildings. 

Construction. 

Lighting.:. 

Ventilation. 

Natural ventilation. 

Dust. 

Heating. 

Water supply. 

The shallow well. 

Deep or artesian wells. 

Driven wells. 

Springs. 

Cisterns. 

Sewage disposal. 

Plumbing. 

Privies. 

Covered can. 

Boxed can. 

L. R. S. privy. 

Disposal of refuse. 

Cleaning. 






4 i. 


*»•— V* - » 


Transmission of disease by insects. 

Flies. 

Mosquitoes. 

Fleas. 

Lice.|. 

Itch-mite (Sarcoptes scatiei) . 

Ticks.L-.OT2 I VS* 

Bedbugs.. 

Roaches. 

Sanitation of vessels. . 

Construction of vessels. 

Water. 

Mosquitoes. 

Rats. 

Camp sanitation. 

The selection of a camp site. 

Camp structures. 

Mess tent and cook tent. 

Water supply. 

Disinfection of water supplies... 

Sewage disposal. 

Final disposal of contents of can 

Garbage disposal. 

Suppression of flies. 


Page. 

17 

17 

17 

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23 

26 

27 

28 
30 

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35 
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39 

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54 

57 

58 

59 

60 
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63 

64 
64 
68 
68 
69 

69 

70 

70 

71 
71 

71 

72 


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4 


TABLE OF CONTENTS. 


Page. 

Personal hygiene. 74 

Diet. 74 

Milk. 75 

Alcoholic liquor. 77 

Exercise. 79 

Fatigue. 80 

Clothing. 80 

Baths. 81 

Care of the mouth and teeth. 81 

Care of the feet. 83 

Childbirth (labor). 84 

Symptoms. 84 

Care and treatment. 85 

Care of the baby. 87 

Care of the sick... 102 

Nursing. 102 

Typhoid fever.•.. 104 

Typhoid prophylaxis. 106 

Typhus fever. 107 

Dysentery. 108 

Pneumonia. 110 

Influenza. 112 

Erysipelas (St. Anthony’s firef. 112 

Diphtheria. 113 

Rheumatism. 115 

Acute rheumatism (rheumatic fever). 116 

Chronic rheumatism. 117 

Muscular rheumatism. 117 

Gonorrheal rheumatism... 118 

Syphilitic rheumatism. 118 

Smallpox. 118 

Vaccination. 120 

Chicken pox. 122 

Measles.. 123 

Scarlet fever. 125 

German measles. 127 

Whooping cough. 127 

Mumps... *. 128 

Consumption (tuberculosis). 129 

Malarial fever. 133 

Yellow fever. 137 

Break-bone fever (dengue). 139 

Spotted fever (cerebro spinal meningitis). 140 

Cholera (epidemic cholera. Asiatic cholera). 141 

Plague. 144 

Beriberi. 146 

Scurvy. 147 

Tapeworms. 147 

Beef tapeworm (Taenia saginata) . 148 

Pork tapeworm (Taenia solium) . 148 

Roundworms. 149 

Roundworm (Ascaris lumbricoides) . 149 

Seatworm (Oxyuris vermicularis) . 150 

Hookworm (Nercator americanus) . 150 
























































TABLE OF CONTENTS. 


5 


Care of the sick—Continued. Page. 

Syphilis. 151 

Soft chancre (chancroid). 153 

Gonorrhea (clap). 154 

Stricture of the urethra. 156 

Coughs and colds. 157 

Croup. 158 

Broncho-pneumonia.. 159 

Pleurisy. 160 

Heart disease. 160 

Palpitation. 161 

Breast pang (angina pectoris).•. 161 

Fainting. 161 

Sore mouth. 162 

Sore throat (tonsillitis, quinsy). 163 

Dyspepsia.,. 164 

Diarrhea. 166 

Cholera morbus (sporadic cholera). 166 

Colic.. 167 

Appendicitis. 169 

Tiles. . 169 

Kidney disease (nephritis). 170 

\cute nephritis. 170 

Chronic nephritis. 170 

Delirium tremens... 171 

Sunstroke... . 172 

Heat cramps. 173 

Headache... 174 

Convulsions. 174 

Poison ivy. 175 

Boils..... 175 

Abscess. 176 

Sore eves. 177 

Conjunctivitis. 177 

Iritis.. 177 

Preventable blindness . 177 

Trachoma. 178 

Earache. 179 

Accumulation of wax in ears. 180 

First aid to the injured. 181 

Wounds. 181 

Description. 181 

The cause of inflamed wounds. 181 

Description of germs. 182 

Varieties of wounds. 183 

Incised wounds. 183 

Lacerated wounds.. 183 

Punctured wounds... 183 

Symptoms of wounds. 184 

General principles of the treatment of wounds. 184 

Infected wounds. 184 

Sterilization. 184 

Preparation or sterilization of the hands. 184 

Sterile dressings... 185 

Germicides and antiseptics. 186 

Boric acid. 187 


























































6 


TABLE OF CONTENTS. 


First aid to the injured—Continued. 

Wounds—Continued. Page. 

Disinfection of wounds. 187 

Wounds which are soiled with dirt, sand, or foreign bodies. 188 

Hydrogen peroxide. 189 

Dressing and treatment of wounds. 189 

Dressing of wounds. 189 

First-aid packets. 190 

Further treatment of wounds. 191 

Small cuts. 191 

Large cuts.. 191 

First-aid treatment. 191 

Treatment when no doctor will be available. 191 

Lacerated wounds. 191 

First-aid treatment. 191 

After treatment. 192 

The Carrel-Dakin solution. 192 

Punctured wounds. 193 

Treatment. 193 

Sewing up a wound. 193 

Inflamed wounds. 194 

Symptoms. 194 

Treatment. 195 

Inflamed wound of the hand. 195 

Inflamed leg ulcers. 196 

Treatment. 196 

Tetanus or lockjaw. 196 

Description. 196 

Symptoms. 196 

Treatment. 197 

Special wounds. 197 

Abrasions. 197 

Symptoms. 197 

Treatment. 197 

Brush burn. 197 

Treatment. 198 

Splinters. 198 

Wounds caused by fishhooks. 198 

Bullet wounds. 198 

First-aid treatment. 198 

After treatment. 198 

Perforating wounds of the chest. 198 

Symptoms. 199 

First-aid treatment. 199 

After treatment. 199 

Scalp wounds. 199 

First-aid treatment. 199 

After treatment. 199 

Wounds of the abdomen. 199 

First-aid treatment of wounds of the abdomen with escape of the 

bowels. 200 

After treatment. 200 

Poisoned wounds. 200 

Description. 200 





















































TABLE OF CONTENTS. 


7 


First aid to the injured—Continued. 

Special wounds—Continued. 

Snake bites (after Da Costa). 

Description. 

Symptoms. 

Treatment. 

Insect stings. 

Bee sting. 

Treatment. 

Stings of centipedes, tarantulas and scorpions. 

Treatment.?. 

Dog bites. 

Treatment of dog bites. 

Symptoms of hydrophobia or rabies in a dog. 

Bites of cats and other small animals. 

Mosquito and flea bites. 

Treatment. 

Hemorrhage or bleeding. 

The circulatory system. 

Ordinary bleeding. 

Oozing. 

Venous hemorrhage. 

Bleeding from varicose veins of the leg.... 

Packing a wound to check hemorrhage. 

Rules for packing wounds. 

Preparation for packing a wound. 

Method of packing. 

Emergency packing. 

Arterial hemorrhage. 

Treatment. 

Tourniquets. 

Provisional tourniquets. 

Method of applying tourniquets to main arteries. 

Tying arteries. 

Method of tying arteries. 

After treatment of severe hemorrhage in general. 

Bleeding from special parts. 

Hemorrhage from the scalp. 

Hemorrhage from the face and forehead. 

Hemorrhage from the neck. 

After treatment. 

Hemorrhage from the trunk. 

Hemorrhage from the palm of the hand. 

Hemorrhage from the nose. 

Hemorrhage from a tooth socket. j 

Hemorrhage from the lungs. 

Description. 

Treatment. 

Hemorrhage from the stomach. 

Description. 

Treatment. 

Hemorrhage from piles. 

Hemorrhage into the abdomen. 

Symptoms. 

First-aid treatment. 

After treatment. 

Summary of the treatment of hemorrhage. 


Laea 

200 

200 

201 

201 

202 

202 

202 

202 

202 

202 

202 

203 

204 
204 
204 
204 

204 

205 

206 
206 
206 
206 
207 
207 

207 

208 
208 
208 
208 
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211 
213 
213 
215 
215 
215 

215 

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216 
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217 

217 

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219 
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219 
219 

























































8 TABLE OF CONTEXTS. 

First aid to the injured—Continued. Page'. 

Shock. 220 

Symptoms of shock. 220 

Treatment. 220 

Bandages and bandaging. 222 

Roller bandage. 222 

Method of applying roller bandages. 222 

The spiral reversed bandage. 223 

Figure-of-eight bandage. 223 

The recurrent bandage. 225 

The triangular bandage. 227 

The many-tailed bandage. 229 

The four-tailed bandage. 229 

The T bandage. 230 

Improvised bandages. 230 

Plasters. 232 

Miscellaneous minor injuries and hernia. 233 

Bruise. 233 

Description. 233 

Symptoms. 233 

Treatment. 233 

Black eye. 233 

Bruises with wounds of the skin. 234 

Strains. 234 

Description. 234 

Symptoms. 234 

Treatment. 234 

Strained or lame back. 234 

Symptoms. 234 

Treatment. 234 

Foreign bodies in the eye. 235 

Treatment. 235 

Removal of foreign bodies which are lodged on the cornea or sight 

of the eye. 235 

Dropping medicine in the eye. 236 

Foreign bodies in the nose. 236 

Foreign bodies in the ear. 237 

Foreign bodies in the throat. 237 

Foreign bodies in the pharynx. 237 

Treatment. 237 

Foreign bodies in the gullet. 237 

Treatment. 238 

Foreign bodies in the larynx. 238 

Treatment. 238 

Rupture or hernia. 238 

Syunptoms. 238 

Strangulated hernia. 239 

Symptoms. 239 

Treatment. 239 

Prevention of strangulated hernia. 239 

Injuries to joints. 240 

Joints. 240 

Description. 240 





















































TABLE OF CONTEXTS. 


9 


First aid to the injured—Continued. 

Injuries to joints—Continued. Pago. 

Sprains. 240 

Description. 240 

Symptoms.'. 240 

Treatment. 240 

Dislocations. 241 

Description. 241 

Causes.. 241 

Symptoms. 241 

First-aid treatment. 242 

Dislocation of the fingers. 242 

Treatment. 242 

Dislocation of the lower jaw. 242 

Treatment. 242 

Dislocation of the shoulder. 242 

Symptoms. 242 

Treatment. 243 

Method of reduction. 243 

Dislocation of collar bone or clavicle.'. 243 

Symptoms. 243 

First-aid treatment. 244 

After treatment. 244 

All other dislocations. 244 

Fractures. 245 

Varieties of fractures. 245 

Symptoms of fracture. 246 

Simple fracture. 246 

Crepitus or grating. 246 

Impacted fractures. 246 

X-rays. 247 

First-aid treatment of simple fracture. 247 

Applying splints. 248 

Permanent splints. 248 

Plaster of Paris casts. 250 

Setting a bone. 250 

Treatment of simple fractures of special parts. 251 

Fracture of the fingers. 251 

Symptoms. 251 

First-aid treatment. 251 

After treatment.• 251 

Fracture of the bones of the hand. 251 

Symptoms. 251 

First-aid treatment. 251 

After treatment. 251 

Fracture of the wrist. 252 

Symptoms. 252 

First-aid treatment. 252 

After treatment. 252 

Fractures of forearm. 252 

Symptoms of fracture of both bones of the forearm. 253 

First-aid treatment. 253 

After treatment. 253 

Fractures around the elbow joint. 253 






















































10 


TABLE OF CONTEXTS. 


First aid to the injured—Continued. 

Fractures—Continued. 

Symptoms of fracture—Continued. 

Treatment of simple fractures—Continued. 

Fractures of the arm. 

Symptoms. 

First-aid treatment. 

After treatment. 

Fracture of the skull. 

Fractures of the base of the skull. 

Symptoms. 

First-aid treatment. 

After treatment. 

Fracture of the nose. 

Symptoms. 

First-aid treatment. 

Fracture of the lower jaw.. 

Symptoms. 

First-aid treatment. 

After treatment. 

Fracture of the collar bone. 

Symptoms. 

First-aid treatment. 

After treatment... 

Fracture of the ribs. 

Symptoms. 

First-aid treatment. 

After treatment. 

Broken neck or back. 

Symptoms. 

First-aid treatment. 

Method of changing or placing a sheet under a very sick or 

injured person. 

After treatment. 

Fractures of the lower extremities. 

Fracture of the thigh bone. 

Symptoms. 

First-aid treatment. 

After treatment. 

Note. 

Fracture of the knee cap. 

Symptoms. 

Treatment. 

After treatment. 

Fracture of the bones of the leg. 

Fractures of both bones of the leg. 

Symptoms. 

First-aid treatment. 

After treatment. 

Pott’s fracture.. 

Symptoms. 

First-aid treatment. 

After treatment. 


Page. 

254 

254 

254 

255 
255 
255 

255 

256 
256 
256 
256 
256 
256 
256 

256 

257 
257 
257 
257 
2o7 

257 

258 
258 
258 
258 
258 
258 


259 

259 

259 

260 
260 
260 
260 
264 
264 
264 
264 

264 

265 
265 
265 
265 

265 * 

266 
266 
266 
266 



















































TABLE OF CONTEXTS. 


11 


First aid to the injured—Continued. 

Fractures—Continu ed. 

Symptoms of fracture—Continued. Page 

Fractures of the bones of the foot. 267 

Symptoms. 267 

First-aid treatment. 267 

After treatment. 267 

Fractures of the toes. 267 

First-aid treatment. 267 

After treatment. 267 

Compound fractures. 267 

Symptoms. 267 

First-aid treatment. 267 

After treatment. 268 

Effects of heat and cold. 269 

Sunburn. 269 

Treatment. 269 

Burns and scalds. 269 

Description. 269 

Treatment. 270 

Severe extensive burns. 271 

First-aid treatment. 271 

After treatment. 271 

Burns from chemicals, such as strong acids or alkalies. 272 

Burns from carbolic acid. 273 

Burns of the eye by chemicals. 273 

Electric burns. 263 

Treatment. 273 

Sunstroke and heat exhaustion. 273 

Effects of cold—frostbite. 274 

Symptoms. 274 

Prevention. 274 

Treatment. 275 

Suffocation. 276 

Respiration. 276 

Respiratory system. 276 

Method of performing artificial respiration. 276 

The Schaefer method. 277 

Causes of suffocation. 278 

Symptoms of suffocation. 278 

Drowning. 279 

Prevention. 279 

Rescue of drowning persons. 279 

Instructions for saving drowning persons by swimming to their relief 279 

Electric shock... 282 

Prevention. 282 

Symptoms. 282 

Treatment. 282 

Gas poisoning. 284 

Prevention. 284 

Symptoms of illuminating gas suffocation. 285 

Treatment. 285 


















































12 TABLE OF CONTEXTS. 

First aid to the injured—Continued. Page. 

Strangulation and hanging. 285 

Treatment. 285 

Unconsciousness. 285 

Description. 285 

Causes of unconsciousness. 286 

General rules for the examination of unconscious persons. 286 

Fainting. 287 

Symptoms. 287 

Treatment.. 287 

Acute alcoholism. 287 

Symptoms of acute alcoholism. -. 288 

Treatment of acute alcoholism.. 288 

Fits. 288 

Treatment of the convulsion. 289 

Brain inj uries. 289 

Concussion. 289 

Sym'ptoms. 289 

Treatment.... 289 

Compression of the brain. 289 

Symptoms. 289 

Apoplexy. 290 

Symptoms. 290 

Wounds of the brain. 290 

Symptoms. 290 

Treatment... 290 

After treatment. 290 

Sunstroke and heat exhaustion. 291 

Poisoning. 291 

General comments. 291 

General treatment of all poisoning. 291 

Emetics. 292 

Special poisons. 292 

Carbolic acid. 292 

Symptoms. 292 

Treatment... 293 

Bichloride of mercury or corrosive sublimate. 293 

Symptoms..’. 293 

Treatment. 293 

Opium, laudanum, morphine, and heroin. 294 

Symptoms. 294 

Treatment. 294 

Strong acids, such as muriatic acid, nitric acid, or sulphuric acid. 294 

Symptoms... 294 

Treatment. 294 

Lye, ammonia water, or other strong alkalies. 294 

Symptoms. 294 

Treatment. 294 

Tincture of iodine. 295 

Symptoms. 295 

Treatment..... 295 

Arsenic. 295 

Symptoms of arsenical poisoning. 295 

First-aid treatment. 29c 






















































TABLE OF CONTENTS. 13 

First aid to the injured—Continued. 

Poisoning—Continued. 

Special poisons—Continued. Page. 

Strychnine. 296 

Symptoms of strychnine poisoning. 296 

First-aid treatment. 296 

Ptomaine poisoning. 296 

Symptoms. 296 

Treatment. 296 

Mushroom poisoning. 297 

Symptoms.’. 297 

Treatment. 297 

General directions for aiding the injured. 297 

General njles as to what to do in case of accident. 298 

Transportation of the injured. 301 

Methods of carrying an unconscious person by one operator. 304 

List of remedies mentioned in this book and their uses. 307 

List of medical and surgical supplies for medicine chest. 312 



















PREFACE TO FIRST EDITION. 


This book has been prepared for the use of the layman in order 
that he may know what measures he should take to protect himself 
from disease and what he should do in case of sudden illness, where 
it is difficult or impossible to secure the services of a physician. 
Written directions very imperfectly supply the place of the physi¬ 
cian and surgeon. No one should depend, if it can be avoided, upon 
the information that can be obtained from a medical handbook. 
When there is sickness always send for a physician, if one is within 
reach, in order that the patient may receive the best attention 
available. 

A supplement on first aid to the injured has been added to the 
book in order that it may be of use in case of accident, and so that 
means may be employed to make the injured person as comfortable 
as possible. The works of Anders, Osier, Eosenau, Harrington, 
Thompson, Keefer. Gatewood, and other authorities have been freely 
drawn upon, and the author wishes to acknowledge his indebtedness 
to them and to the officers of the Public Health Service for the valu¬ 
able assistance given in the preparation of this book. While most 
of the articles on disease are new, parts of some of them have been 
taken from the Handbook of the Ship’s Medicine Chest, prepared in 
1904 by Surgeon George W. Stoner, and from the revised edition 
of this book, published in 1915 for the use of the United States 
Lighthouse Service. 

W. G. Stimpson. 

July 20, 1917. 

15 


PREFACE TO FIRST AID TO THE INJURED. 


In addition to strictly first-aid measures, in many instances brief 
notes on after treatment have been added in the hope of making this 
publication more useful to the masters of vessels, lighthouse keepers, 
and others, who by force of circumstances are sometimes compelled 
to undertake the treatment of injuries without the expectation of 
medical aid. 

In preparing this manual, numerous surgical authorities have been 
consulted, but special mention should be made of Da Costa's Modern 
Surgery, and Scudder’s Fractures and Dislocations, from which 
sources much valuable material and many illustrations have been 
taken, and for which due acknowledgment is gratefully made. 

M. H. Foster. 

May 15, 1918. 


16 


PREVENTION OF DISEASE. 


INTRODUCTION. 

Sickness causes loss of time, great expense, much suffering, and, 
frequently, death. When the misery and distress produced by it are 
taken into account, the importance of its prevention can not be over¬ 
estimated. It may often be easily avoided by simple means. Scurvy, 
which was once the scourge of the seas,.now rarely occurs on vessels. 
This is due to the addition of fresh fruits, vegetables, or lime juice to 
the seaman's ration. Necrosis of the jaw, or phossy jaw, which was 
formerly so common among workmen in match factories, is now pre¬ 
vented by the use of red phosphorus instead of white phosphorus in 
this industry. Yellow fever has been stamped out of many places by 
killing the mosquitoes which convey the disease. 

To protect ourselves against disease, it is necessary to know what 
agencies are harmful to the human body and what measures should 
be taken to protect the body from them. It has been ascertained, for 
instance, that in order to keep well, the temperature and humidity of 
the air in buildings must be regulated; sewage must be disposed of 
in such a manner as not to contaminate the water supply or pollute 
the soil; the body must be protected from the bites of insects which 
spread disease; and precautions must be taken to prevent the trans¬ 
mission of disease from one person to another. It will thus be readily 
seen that freedom from disease depends upon conditions intimately 
associated with the body and its environment. 


SANITATION OF BUILDINGS. 

Construction. 


Buildings should not be placed upon made land on account of the 
organic matter which such land is liable to contain. Clays, alluvial 
soils, and badly drained places should be avoided, if possible. The 
best sites are those where the ground is composed of gravels, sand, or 
where it is underlaid by granite, limestone, or other rock. The build- 
ing should be surrounded on all sides by an open space, if possible. 
It should have a cellar underneath with a cement floor. The walls of 
the cellar should extend several feet above the surface of the ground 


40(571 


24 - 


17 


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18 


PR EVENT! OX OF DISEASE AND CARE OF SICK. 


and should have damp-proof wall courses. (Fig. 1.) The spaces 
between the floor joists where they rest upon the foundation should 
be filled in, or the joists should be embedded in the foundation Avail, 
so that there will be no opening for rats to reach the space betAveen 
the plaster and the outside sheathing and climb up into the house. 
The cellar should have small AvindoAVS on all sides to give light and 
ventilation. If there is no cellar, the building should be placed upon 
piers made of Avood, brick, stone, or concrete, to provide free circu¬ 
lation of air under the building. The space betAveen the piers should 
not be inclosed with lattice work, but should be left open in order that 
the area beneath the house may not become a hiding place for rats or 
other small animals. Neither the cellar nor the place underneath the 
house should be used for the storage of lumber, empty barrels, boxes, 
old furniture, or rubbish of any description, as rats are liable to breed 
in such places and become a menace to the health of the people living 

in the house. Roof gut¬ 
ters should be put on the 
house with sufficient slope 
to preA r ent water standing 
in them, for such water 
may be used by mos- 
quitoes as breeding places 
and cause much annoyance 
and sickness to the in¬ 
mates of the house. Win- 
doAvs should be placed so 
as to give plenty of light 
in each room. The area 
of window space to floor 
space should not be less than 1:10, but a ratio of 1:6 is more 
desirable. As an illustration, a room measuring 18 by 24 feet, mak¬ 
ing a floor area of 432 square feet, should contain four windows meas¬ 
uring 3 by 6 feet, a total window area of 72 square feet. Two small 
windows are better than one large window if it is possible to place 
each on a different side of the room, as a freer circulation of air can 
then be obtained through the room. 

All openings in the house should be screened to keep out rats, 
flies, and mosquitoes. Surgeon von Ezdorf gives the following direc¬ 
tions for screening a building: 

To be of proper construction, a doorframe should be made of cypress or 
other seasoned Avood 1 inch to IT inches thick, well braced and painted. The 
wire should be of 16 or 18 mesh. The lower panel should be covered on the 
inner side with a one-fourth inch mesh wire guard to protect the screening. 
If this is not provided, tAvo or three strips of wood 1 inch wide, set 3 inches 
apart, should be nailed across the loAver panel and tAvo or three such strips of 



Fig. 






•• <V Sv • 

-Damp-proof course for 


foundations of 


buildings (indicated by the heavy line)—Keeler. 



























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Fig. 2.—Screen door closed; canvas on lower end of door. Cross strips and a 
diagonal brace prevent the screen door from sagging. 





















































Fig. 3.—Fireplace properly sealed against mosquitoes, covered with unbleached 
muslin and fixed into place by adhesive plaster. 



Fig. 4.—Windows must be screened outside the sash, 













































PREVENTION OF DISEASE AND CARE OF SICK. 


19 


wood placed over the lower portion of the top panel. This provision is made 
for the protection of the screening in pushing the door open. 

It is not an unsual experience in certain climates to have doors, even the 
best, swell or warp, so that they will not close, and after planing them so 
that they will close the wood will shrink in warm weather, leaving a crack 
one-half inch or more, where mosquitoes might enter. 

An easy fitting door, fully one-fourth inch clear all around the edge, is best, 
and to make it mosquito proof it will be necessary only to tack a strip of light 
canvas 1 inch wide around the top and one side of the door facing on the 
outer side (not on the screen door), so that when the door closes this canvas 
will take up all the lost or extra space. To the lower edge, on the outer 
side of the door, a strip of canvas may be tacked to cover any opening existing. 
This measure is not ornamental, but it is effective. 

Some use strips of wood nailed to the inner side of the door jambs against 
which the door strikes. This is usually satisfactory, but doors will warp 
lengthwise, so that the top and bottom will not strike such facing strips, and 
thus leave spaces at the top and bottom. The canvas strips suggested have 
been found to be more generally satisfactory to meet this defect. 

Where mosquitoes are in great abundance, the construction of a screened 
vestibule with two entrance doors often becomes necessary. 

The defects most commonly observed in screen doors are that they do not 
fit, and that they are made of very thin and unseasoned wood frames and of 
coarse (12 mesh) wire netting. 

There are on the market ready-made door and window screens made of 
three-fourths inch wood framing and finished with 12 and 14 mesh wire. 
These are, to say the least, very poor investments, and within a few weeks 
after use are often next to useless for the purpose intended. 

All doors should be made to open outward and have springs which 
will keep them closed firmly. 

A window is probably the most common place of entrance for mosquitoes. 
Windows are frequently screened with a view to easy removal of the screen 
and for the easy opening and closing of shutters. For this reason the tele¬ 
scoping and adjustable screens are most commonly used and sold. This type 
of screen is made of wood or agle-iron material for the frames and furnished 
with 12 or 14 mesh iron wire. At best, these screens are not effective, ns 
mosquitoes will work their way between the lapping ends. The halfway or 
half-window sliding screens provided with guides, well made, are efficient but 
costly. When using this type, the window must be kept wide open so that the 
sash will fit close to the frame of the screen. 

The most efficient method of screening a window is to screen the entire 
opening. A well-fitting screen frame which is screwed into place so that it can 
be removed at the end of the season is probably the best. 

Another method, less expensive than that of constructing a frame, is to cover 
the window with wire netting tacked to the window facing and cover the edges 
with narrow strips of wood nailed down to keep the wire netting flat against 
the woodwork and hold it firmly in place. Cotton mosquito netting, which will 
serve for a period of time and possibly for the entire season, provided care is 
taken with it, might be used in this way. 

Where shutters or outer blinds are also used, a tight-fitting frame may be 
employed, with the lower end of the frame material arranged with a trapdoor 
covered with canvas, or the frame may be made to extend within 4 to 6 inches 
of the sill and the remainder closed in with a board on hinges heavy canvas 
covering. 


20 


PREVENTION OF DISEASE AND CARE OF SICK. 


Other places to be absolutely screened are the fireplaces, openings into 
chimneys for stove pipes, drain holes, ice-box drips through floors, and the like. 

The chimneys above the fireplaces must not merely be stuffed with news¬ 
papers and sacking, but should be absolutely closed with cotton material or 
netting. 

The complaint is often made that a great deal of money is spent in screening 
a house and that it has proved useless, and, upon questioning or examining such 
a place we find that the occupant has failed to tightly screen the fireplaces, not 
knowing that mosquitoes will enter through the chimney. 

The fireplaces should therefore be completely sealed. If there is a metal 
cover or fireboard used to close the fireplace during the summer, then this 
should have the openings along the edges completely closed by pasting paper 
over them, or adhesive plaster might be used. 

A piece of unbleached sheeting or heavy paper may be used to close the 
opening. This is to be tacked into place and laths are to be used to hold the 
edges firm. The paper might be pasted. 

If the fireplace is constructed of iron, brick, tile, stone, or other material not 
permitting the use of nails or tacks, adhesive plaster 2 inches wide may be em¬ 
ployed, one half of the width being used to hold the edge of the cotton ma¬ 
terial, the other half to fasten it in place. The hearth is usually of stone or 
brick so that adhesive plaster will be serviceable in any case. 

If the porches are screened, the holes at the bottom for draining off water 
should also be screened. Every precaution must be taken to close all openings 
securely. If the house is not of tight construction, it may require papering of 
the interior of the rooms. 

The walks around the building should be made of brick or cement, 
or, if this is too expensive, of gravel and cinders. Planks should not 
be used for this purpose as the spaces under the planks offer easy 
access to rats and form a convenient harboring place. The keeping 
of chickens should not be allowed in cities or villages, but if so kept 
the chicken yard should be protected from rats by a wall of concrete 
1 foot high extending 2 feet downward into the ground. The yard 
should be surrounded by wire fencing about 6 feet high of mesh not 
larger than a half inch. The door leading into the inclosure should 
be closed when not in use. Chickens may be allowed to roam at will, 
but should be fed only in this rat-proof yard. 

Small stables should have an elevation of 2 feet, with pier under¬ 
pinning. and the floor should be tight to prevent grain falling 
through it. Large stables should have concrete flooring placed flat 
on the ground with a concrete wall surrounding. The wall should 
extend at least 1 foot above the surface of the ground and 2 feet be¬ 
low it. Windows and doors should be screened, and all grain should 
be kept in metal-lined containers. 

Lighting. 

Natural illumination is that provided by the direct rays of the 
sun or light reflected by the sky. In factories, workshops, and other 
places in cities where daylight illumination is reduced by the walls 


PREVENTION OF DISEASE AND CARE OF SICK. 


21 


of neighboring buildings, an increased illumination may be obtained 
by the use of ribbed glass which causes a larger portion of the light 
to be refracted into the building. (Fig. 5.) Windows should always 
be kept clean, as the amount of light entering the room may be 
reduced 40 per cent by dirt upon the glass. 

Artificial illumination is that which must be provided at night 
or when daylight illumination is insufficient. The source of the 
light may be from the burning of hard fats as in candles, mineral oils 
as in lamps, illuminating gas, or electricity. A spermaceti candle 



Fig. 5. —Typical relation of loft buildings in the Women’s Garment Industries, New York 
City, to the sky and adjacent structures. The two lower sections show the action of 
prismatic glass in refracting the rays of light into the room. 


burning two grains a minute is used as the standard for measuring 
artificial illumination; a foot candle is the lighting effect produced 
upon an object by a standard candle at a distance of 1 foot; at 2 
feet, the effect would be not one-half foot candle, but one-fourtli 
foot candle, etc. A lamp which would give off 16 candlepower uni¬ 
formly in all directions would produce a uniform illumination of 
1 foot candle at a distance of 4 feet in any direction. Lamps 
should be kept scrupulously clean, should be filled and have their 
wicks carefully trimmed each day, as otherwise they will emit a dis¬ 
agreeable odor. 





























PREVENTION OF DISEASE AND CARE OF SICK. 


90 


Illuminating gas may be either coal gas, water gas, or natural gas. 

Coal gas is produced by heating coal in closed chambers and the 
gases thus obtained, after being freed from certain impurities, are 
stored and distributed as needed through pipes to buildings for light¬ 
ing and cooking purposes. Water gas is made from coke or anthra¬ 
cite coal, steam, and petroleum. The poisonous properties of both 
coal gas and water gas are due to carbon monoxide, a gas known 
to miners as “ white damp.” Water gas contains 35 per cent carbon 
monoxide, coal gas from 6 to 7 per cent, and natural gas only 0.21 per 
cent. Illuminating gas (except natural gas) as now used in cities is 
a mixture of coal gas and water gas, most municipalities limiting by 
ordinance the amount of water gas in the mixture to 10 per cent. 

The symptoms caused by poisoning from illutnmating gas may be 
either acute or chronic. In acute poisoning they are violent head¬ 
ache, vertigo, shortness of breath, weakness of the legs, convulsions, 
and unconsciousness. The carbon monoxide unites with the coloring 
matter of the blood and prevents it from taking oxygen to the tissues. 
The danger of breathing this gas in small quantities is that a con¬ 
dition develops in which the patient is dull and listless, can not sleep 
at night, his gait is slow, and his memory bad. Some of the symp¬ 
toms of acute poisoning may also be present. 

As 0.4 per cent of carbon monoxide in the air will produce fatal 
results, the necessity for exercising care in the use of illuminating 
gas is evident. Gas pipes and street mains should be tight so that 
none of the gas can leak into rooms and produce poisoning. Gas 
jets should not be left burning where a gust of air may blow them 
out and let the gas escape into the room. 

The treatment in acute cases of carbon monoxide poisoning con¬ 
sists of loosening the clothing about the neck and chest, performing 
artificial respiration (p. 276). and oxygen should be given by inhala¬ 
tion. If the patient is conscious and able to swallow, hot coffee or 
tea should be administered. Dr. W. G. Fralick, of 33 East Sixtieth 
Street, New York City, has had great success in the department of 
charities hospitals and other hospitals in New York treating these 
cases by an intravenous isotonic solution of sodium hypochlorite 
used in strength of ^ to 1 per cent, in quantities of 500 to 1,000 c.c., 
repeated, if necessary, in four hours. The hypochlorite solution de¬ 
stroys the carbon monoxide hemoglobin b}^ oxidation and sets the 
hemoglobin free so that it can again take oxygen to the tissues. 

, Electricity is used to supply light by the direct method, where 
the light is refracted directly downward; the semi-indirect, where 
a part of the light passes through a frosted bowT and the rest is 
thrown upon the ceiling and reflected therefrom over the room; 
and the indirect method, in which the bulbs are contained in an 
opaque bowl and all the light received in the room is reflected from 



Fig. 6.—Illumination of pressing tables, shop No. 12. Gas arc in clear globe and low- 
suspended fishtail burners produce glare effects. 



Fig. 7.—Pressing table, shop No. 11, with opal extensive bowl 
type reflectors, 250watt tungsten lamps. The illumination 
was good. The lamps are well out of the visual field of the 
worker. 


























Fig. 9.—Humidifier. 




Fig. 11.—Bacteria given off by pa- Fig. 12.—Showing method of using pot and pan in 

rient in sneezing. Tuberculosis often fumigating with sulphur, 

spreads through germs given off in 
sneezing. 



Fig. 30.—Dustless furniture duster. 


Fig. 31.—Dust less floor and wall duster. Fitted 
with two-section handle. Attached section, 12 
inches in length. Detached section, 50 inches 
in length. 

















PREVENTION OF DISEASE AND CARE OF SICK. 


23 


the ceiling. The amount of light which should be supplied for gen¬ 
eral illumination naturally varies with conditions. The following 
table taken from the American Standard Lighting Code of the 
American Engineering Standards Committee gives the minimum 
permissible and the desirable intensities which should be maintained: 


Illumination intensity at the work in foot candles. 


Room or space to be illuminated. 

Ordinary 

practice. 

Minim urn. 

Productive 

intensities. 

(a) Roadways and yard thoroughfares. 

0.05- 0.25 

0.02 


( b ) Storage spaces..'.~. 


• 25 


(c) Stairways, passageways, aisles. 

.75- 2.00 

. 25 


(d) Rough manufacturing, such as rough machining, rough assem¬ 
bling, rough bench work, foundry floor work. 

2.00- 4.00 

1.25 

6 

(c) Rough manufacturing, invoicing closer discrimination of detail. 

3.00-6.00 

2.00 

10 

(/) Fine manufacturing, such as fine lathe work, pattern and tool 
making, light-colored textiles. 

4.00- 8.00 

3.00 

15 

((j) Special cases of fine work, such as watchmaking, engraving, 
drafting, dark-colored textiles. 

10.00-15.00 

5.00 

26 

(/t) Office work, such as accounting, typewriting, etc. 

- - w ‘ * . • 

4.00- 8.00 

3.00 

15 


With modern illuminating units and suitable reflectors, a current 
consumption of about 1 watt to each square foot of surface should 
yield an intensity of about 4 foot candles. Every effort should be 
made to prevent glare , which is present when some object in the field 
of vision is brighter than the object toward which the eye is directed. 
Glare makes seeing difficult and is injurious to the eyes. Walls 
should be finished with a yellow or light-green matte surface. 
Brown or deep green absorb light and make the room dark. White 
walls and polished surfaces cause glare. Welsbach lights and elec¬ 
tric bulbs should be frosted or they should be provided with deep- 
bowl or cone reflectors extending below the light so that the eyes 
will be protected from the direct rays. Fishtail gas burners and 
other open lights should be discarded on account of the flickering 
of the flame and the glare caused bv the exposed light. 

Ventilation. 

Ventilation is the process by which air in inclosed spaces is fre¬ 
quently changed. By this means the bad effects of unfavorable air 
conditions are to a great extent overcome. These effects depend to a 
large extent upon the temperature and humidity of the air. The 
humidity is usually expressed as relative humidity, which is the 
ratio of the amount of moisture in the air at a given temperature 
compared with the amount it is possible for the air to contain at that 
temperature. It is determined by means of an instrument known as 
the Sling psyclirometer (fig. 8), which consists of a pair of ther¬ 
mometers provided with a handle which permits them to be whirled 
rapidly. The bulb of the lower of the two thermometers is covered 























24 


PREVENTION OF DISEASE AND CARE OF SICK. 


with cloth, which is wet at the time the instrument is used. The 
thermometers are whirled for about a minute and the difference be¬ 
tween the two noted. The relative humidity can then be easily 
calculated by means of a table furnished with the instrument. 

•j 

At a temperature of 86° F. and a relative humidity of 80 per cent, 
a person begins to feel uncomfortable; there is a disinclination to 
work; the temperature of the body is raised, and the heart's action 
is accelerated. Under higher temperature there is frequently head¬ 
ache, nausea, vomiting, and considerable prostration. When the heat 
and relative humidity are excessive, the temperature of the body may 
rise to 104° F. or over, which, if not relieved, may be followed by 
unconsciousness and the symptoms of heat stroke. For a description 
of this condition see page 172. It is the combination of heat and 

moisture which makes the air intolerable. A man 
can stand without discomfort a much higher room 
temperature if the air is dry. The high temperature 
of the air diminishes direct loss of heat from the 
body, and the presence of moisture decreases evapo¬ 
ration of perspiration. Both reduce the elimination 
of body heat and cause a sensation of uneasiness 
and illness, especially when the air is stagnant. 
These symptoms are ameliorated by setting the air 
in motion, either by a fan or by opening the doors 
and windows and allowing a current of air to blow 
through the room. Cool air replaces the envelope 
of stagnant, hot, moist air that surrounds the body, 
the blood in the vessels of the surface of the body 
is cooled, the temperature of the body falls, and a 
feeling of well-being ensues. 

In winter the heated air of buildings is usually 
too dry; in fact, the relative humidity is often less 
than 20 per cent, which is drier than the air of a desert, the relative 
humidity of the driest climate of this continent being seldom less 
than 30 per cent. Harrington, in his book on Practical Hygiene, 

savs: 

%/ 

When outdoor air is heated so as to maintain an even temperature of 70° F., 
but with no addition of watery vapor, its capacity for absorbing moisture is 
very much increased, and it will take it up from all moist objects with which 
it comes in contact. It will take it from the skin, from the mucous membranes 
of the mouth, nose, and respiratory tract; from furniture made from wood 
■which, in the process of kiln drying, was never brought to such dryness; from 
the leather binding of books, causing them to crack and fall to pieces; and 
from plants, which, in consequence, wither and die. It thus causes more or 
less dryness of the skin, irritation of the throat, and cough. It causes also 
need of a higher temperature to give the same sensation of warmth and com¬ 
fort than is the case with air containing a normal amount of moisture. Air 



Fig. 8.—Sling psy- 
chrometer. 
















PREVENTION OF DISEASE AND CARE OF SICK. 


25 


at 25° F. saturated with moisture and then heated to 70° F., would need more 
than 0.5 pint of water in every 1,000 cubic feet to give it a humidity of 65 per 

cent. 

The relative humidity in buildings in wintertime should be at 
least 50 per cent. The nearer it is to the temperature of the room 
the more comfortable the room will be; but if the weather outside is 
very cold and the amount of moisture in the room is great, drops of 
water will collect on the windowpanes, making it difficult to see 
through the windows. 

Moisture may be imparted to the air by means of humidifiers, one 
of which is shown in figure 9. This apparatus consists of a con¬ 
tainer, which holds about a gallon of water and which has a trough 
at its lower portion. The trough extends lengthwise between the 
coils of the radiator. In the trough is placed a large felt pad which 
extends up between the coils. Water absorbed by the pad and 
evaporated by the heat of the radiator is replaced by water in the 
trough, -which is kept filled by means of a float valve. Where there is 
sufficient moisture in the air, an indoor temperature of 62° to 68° F. 
will be found to be comfortable. 

Good effects of cold air are well known and many persons sleep out 
of doors on porches. Wherever possible, in any climate, one should 
sleep with the windows of his bedroom open. These should be wide 
open so as to have a good circulation of air. Persons suffering from 
pneumonia are now treated in a room without heat, the cold air 
entering through open windows being one of the best remedies that 
can be employed for this disease. In certain cases prolonged ex¬ 
posure to cold, damp, air may be injurious. Old people, children, 
and persons suffering from kidney diseases or rheumatism should not 
expose themselves to it. Healthy persons, however, if well covered, 
will not be injured by it. 

Drafts are only dangerous to robust persons when they cause a 
chilling of the body. Children and old persons, owing to their feeble 
resistance to constant changes, should not expose themselves to 
drafts. A draft may do harm to a strong, well person if he ex¬ 
poses himself to it when his body is in an overheated condition. It 
may increase the tendency to catch cold or to have pneumonia. 
When the body is hot there is a large quantity of blood in the ves¬ 
sels of the surface of the body. Cold air suddenly thrown upon the 
skin causes these vessels to contract, bv which means the blood is 

✓ C' 

driven inward, producing a congestion of the internal organs. It is 
not positively known that this internal congestion causes a person 
to catch cold, but it is one of the explanations that has been made 
to account for this condition. 


26 


PREVENTION OF DISEASE AND CARE OF SICK. 


Persons who live in poorly ventilated houses for a long period of 
time become pale. They are inclined to be thin and usually look 
undernourished. Their resistance to disease is lowered and they 
are liable to contract colds, pneumonia, consumption, and other 
diseases. 

Natural Ventilation. 


Natural ventilation is that which takes place through openings, 



such as doors, windows, and cracks, in buildings. It also takes 
place, to some extent, through the materials of which the building 
is constructed. This form of ventilation depends upon changes in 

temperature. Cold 
air entering a room 
falls to the bottom. 
As it b e c o m e s 
warm it expands 
and either rises to 
the top of the room 
or goes out through 
the fireplace or 
stoves, where it as¬ 
sists in the combus¬ 
tion of fuel. A 
constant circula¬ 
tion of air is thus 
0 maintained. There 
are various ways 
of assisting this 


Fig. 13.—Diagrammatic sketch of various provisions for ven¬ 
tilation. A, Sash window with Ilinckes-Bird’s arrange¬ 
ment. B, Hopper sash light falling inward. C, Louvred 
outlets. D, McKinnell’s ventilator. E, Sheringham’s valve. 
F, Tobin’s tube (showing valve open). G, Ellison's con¬ 
ical bricks. II and I, Grid ventilators below floor joists. 
(From “ Hygiene and Public Health,” by Drs. L. C. Parkes 
and II. It. Kenwood, London ; II. K. Lewis, Philadelphia, 
Blakiston, 1911.) 


process. Air ducts 
may be placed in 
the inner wall, one 
at the top for an 
inlet and another 
at the bottom for 
an outlet. A win¬ 


dow may be slightly raised for an inlet, a glass or wooden screen 
being used to deflect the air upward (fig. 10), and an outlet pipe 
may be placed over the fireplace, or a ventilator may surround the 
stovepipe. Figure 13 is a diagrammatic sketch of various provisions 
for ventilation. In large buildings in closely built-up cities, mines, 
big passenger vessels, and the like, some form of mechanical ventila¬ 
tion is necessary, as it would be impossible otherwise to remain in 
them. Ventilation is accomplished in these structures by three 
methods, one in which the air is forced into the room, another in 
which air is drawn out of the room, the third being a combination 
of the first two methods. 




















































































PREVENTION OF DISEASE AND CARE OF SICK. 


27 


The stream of air that is constantly passing through a well ven¬ 
tilated room not only reduces the temperature but sweeps away 
harmful gases resulting from the combustion of candles, coal oil, 
and illuminating gases. It also blows out dust, bacteria, and foul 
odors. There are sound reasons for the belief that diseases like 
consumption, pneumonia, and colds are transmitted by contact with 
persons suffering with or carrying the germs of the disease, which 
probably are not borne for any great distance through the air. 
The transmission may occur when the carrier of the germ coughs, 
sneezes, or otherwise sprays the secretion of mouth, nose, or throat 
over the faces of persons near him in street cars, theaters, or other 
places where persons collect in crowds. 

Dust. 

Dust is especially dangerous in certain occupations. It may be 
called “ The greatest enemy of the workman." It may be of organic 
or inorganic origin. It is usually considered that dust of organic 
origin, such as cotton, wool, wood, coal, and the like, is not so harm¬ 
ful as dust of inorganic origin, such as granite dust. This is sup¬ 
posedly due to the hard, sharp angles of the particles and to the fact 
that these dusts differ in their chemical composition from the ele¬ 
ments of which the blood is normally composed. In addition to 
these the air may contain metallic poisons and toxic gases, fumes, 
and vapors. Sommerfeld. in the table shown below, gives the death 
rate per thousand from consumption of inhabitants of Berlin en¬ 
gaged in various trades where dust is a prominent factor: 


(From “The Occupational Diseases,” Thompson, p. 7.) 


Occupations. 

Deaths 
due to 
pulmonary 
tuberculosis 
per 1,000. 

Occupations. 

• 

Deaths 
due to 
pulmonary 
tuberculosis 
per 1,000. 

#1% Nnnrhistv.... 

2.39 

(2) Dustv—Continued. 


*2) Dnstv. .... 

5.42 

(o) Organic dusts. 

5.64 

(a) Metallic dusts. 

5.84 

Leather, furs, feathers. 

4.45 

Copper. 

5.31 

Wool and cotton. 

5.35 

Iron. 

5.55 

Wood and paper. 

5.96 

Lead. 

7.79 

Tobacco...!... 

S. 47 

(b) Mineral dust. 

4.42 



Pottery. 

14.00 



Masons. 

4.26 




Wool sorters’ disease, or anthrax pneumonia, is an example of 
infection caused by the inhalation of animal dust. The germs of 
anthrax are breathed in with the dust from the wool and cause 
pneumonia. Irritating dust, such as is present during the cutting 
or polishing of granite, sets up a chronic irritation of the air pas¬ 
sages with the production of new fibrous tissue not normally present 
in the lungs. Workers whose lungs are in this condition are con¬ 
siderably more susceptible to tuberculosis than others. Soft-coal 
dust is less dangerous than hard-coal dust; miners working in bitu¬ 
minous-coal fields are not especially liable to tuberculosis. The bad 
































28 


PREVENTION OF DISEASE AND CARE OF SICK. 


effects of dusty working places may be obviated by the use of res- 
pirators. These are, however, rather uncomfortable to wear, so that 
the better way is to remove the dust at its source by mechanical 
devices or to prevent its accumulation in the air by the use of water. 

Heating. 

ddie proper heating of a building depends to a large extent upon 
ventilation. Most houses are imperfectly ventilated, with the result 
that as the air is abnormally dry, they are overheated, for dry air 
causes excessive evaporation and gives a sense of chilliness. Air at a 
temperature of 65° F. and a relative humidity of 70 per cent has a 
greater feeling of warmth and is more comfortable than air at a 
temperature of 73° F. with only 50 per cent moisture. As many 
heated rooms have a relative humidity of less than 50 per cent, the 
temperature of the air has to be maintained at a much higher degree 
than would be necessary if the proper amount of moisture were pres¬ 
ent. On account of this chilly feeling due to dry air, many persons 
wear too much clothing while indoors, with the result that a layer 
of moisture covers the skin, rendering the person susceptible to drafts 
and to the catching of cold. If the proper humidity is maintained 
indoors, a person therein need not wear warmer clothes in winter than 
in summer. When going outdoors the body may be protected from 
cold by heavy wraps. 

Buildings are heated by fireplaces, stoves, hot-air furnaces, hot 
water, or steam, and to a small extent by electricity. An open fire is 
cheerful, and the hot chimney acts as a good ventilator for the room. 
It has been estimated that a coal fire burning briskly in a fireplace 
of the usual size will cause 18,000 cubic feet of air to pass up the 
chimney in an hour, but as seven-eighths of the heat of the fuel is 
carried up the chimney and lost, this method of heating is wasteful 
and inadequate for cold places, as many parts of the room in which 
the fireplace is located are insufficiently warmed, the heat reaching 
only those persons near the grate. It is similar in some respects to a 
fire outdoors, where the portion of the body turned toward the fire 
becomes too warm, while the opposite side is cold. 

A stove is better than a fireplace in that it radiates heat in all 
directions if it is set out in a room. The air also coming in contact 
with the hot stove ascends and mixes with the rest of the air in the 
room, thereby giving a more even temperature. The hot fire and 
the stovepipe act as a ventilator, but as the amount of air passing 
through a stove is much smaller than that which ascends the chim¬ 
ney from an open fire, air conditions in a room heated by a stove 
are nnt as good as when a fireplace is used. An extremely poisonous 
gas. known as carbon monoxide (p. 22), may be produced in stoves 
in which combustion is incomplete and may pass out of cracks, if 
the dampers are closed, and there is not a free circulation of air to 


PREVENTION OF DISEASE AND CARE OF SICK. 


29 


carry the coal gases up the chimney. Cast-iron stoves, when red hot, 
may also allow, it is believed, this gas to pass into the room. A hot 
stove is also objectionable for the reason that small particles of 
organic matter in the air when falling on the stove become charred 
and yield unpleasant odors. These conditions may be avoided by 
not allowing stoves to become too hot, by seeing that there are no 
cracks in the fire box, and by not completely closing the dampers. 

A gas stove or water heater should have a hood over it connected 
by a pipe with the chimney to carry off the products of combustion. 
With good ventilation, as by open windows, it may be possible to 
get along without this connection to the chimney, but care should 
be taken that no gas leaks from the feeding pipes, especially where 
rubber tubes are used, and that burners are free from soot, or other¬ 
wise the air of the room may be contaminated bv carbon monoxide. 
This gas is less likely to be given off from oil stoves, as the perfect 
combustion of good oil does not produce this gas. An oil stove 
should not, however, be used in a tightly closed room. 

Hot-air furnaces .—In this method of heating the air is drawn from 
the outside, through a pipe, over hot plates or tubes in the furnace, 
and conducted by ducts to different rooms of the building. Circu¬ 
lation of air in such a building is usually good, but the air is exces¬ 
sively dry from passing through the furnace, the water pans in 
these structures being entirely too small to supply the requisite 
amount of moisture. The futility of trying to supply the necessary 
moisture by contrivances of this kind is evident when the quantity 
of water that should be evaporated for this purpose is considered. 
For example. Surgeon Clark of the United States Public Health 
Service cites the following: 

To supply a classroom of 35 pupils with 1.800 cubic feet of air each per hour 
at 70° F., with a relative humidity of 70 per cent for 7 hours, would re¬ 
quire the evaporation of over 30 gallons of water, when outside air is taken 
at a temperature of 30° F., with a relative humidity of 70 per cent. 

Ilot-water and steam pipes .—The system of heating buildings by 
circulating steam or hot water through pipes is efficient so far as the 
warming of all parts of the building to which the pipes lead is con¬ 
cerned. but is open to the same objection as furnace heat, inasmuch 
as the air is rendered verv drv by their use. In some cases the radia- 
tor is placed under a window and an air duct leads to the outside of 
the building. The cold air becomes heated in entering the room by 
passing through the hot radiator. This plan is fairly efficient in 
mild weather, but when the temperature is low the air is frequently 
insufficiently heated, and persons sitting in the room are apt to close 
the air duct. Another objection is that the air in cold weather is 
usually dry, the relative humidity being sometimes 50 per cent or 
less, and passing through the radiator renders it still drier. In other 
40071 °— 23-3 


30 


PREVENTION OF DISEASE AND CARE OF SICK. 


cases hot water and steam pipes do not extend over the building, 
but the air is heated by passing over hot pipes in the basement. 
This method is little different, from furnace heat and is no better 
than the latter unless moisture is added to the incoming air by means 
of steam jets or in some other way. 

Electric heating .—This method of heating is very little used on 
account of the expense. It consists simply of resistance coils which 
heat the room b}^ radiation and convection. Heating by this method 
has the same disadvantage as hot water and steam and requires 
special apparatus to provide moisture to the air. 

Water Supply. 

Good water is essential to life. It comprises about 70 per cent of 
the body weight and is necessary to provide elasticity and supple¬ 
ness to the muscles, bones, cartilages, and tendons, to moisten various 
parts of the body so that they can perform their functions, and to 
act as a solvent for the food so that it may be absorbed. It also pro¬ 
vides a fluid medium for the blood and lymph by which nutritive 
substances are taken to all parts of the body and waste products are 
removed. The quantity of water needed for each person for drinking 
and cooking is about 1 gallon per day; for washing and other pur¬ 
poses about 16 gallons per day. Many cities having large manu¬ 
facturing plants supply a much greater quantity for each person; 
some as much as 250 gallons per day. 

Great care should be taken to prevent water that is to be used by 
human beings from being contaminated with the germs of disease; 
typhoid fever, diarrhea, dysentery, cholera, tuberculosis, and prob¬ 
ably other diseases may be acquired in this way. The eggs of in¬ 
testinal worms are sometimes present in water, and if this water is 
swallowed full size worms may develop in the body. These germs 
and parasites get into water through the discharges of infected 
human beings or animals, and in order to prevent well persons from 
becoming ill it is necessary that water should be kept free from 
human and animal filth or that steps be taken to remove it before the 
water is used. Water may be of good color, have a pleasant taste and 
no odor, and still be unfit to drink. Its quality can not be determined 
until the place from which it has been obtained has been inspected 
and an examination made to determine what substances it contains 
and if any disease germs or animal parasites are present. 

Water to supply cities is, for the most part, obtained from rivers 
and lakes, or from a reservoir made by throwing a dam across a 
small stream. If possible the drainage area from which the water 
is derived is in the hills or the mountains, where there are few. if 
any, habitations, for all surface water is contaminated by washings 
from the soil. Many privies are placed over streams or so near one 


PREVENTION OF DISEASE AND CARE OF SICK. 


31 


that their contents are carried into it whenever there is a heavy 

rain. Stables and pigpens on the sidehills drain into the streams 

in the valleys. It is never safe to drink water from a stream; in 

thinly settled sections the danger may be small, but it should be 

remembered that if the discharges from one person suffering from 

typhoid fever are emptied, without previous disinfection, into a 

stream, or such discharges are washed from a privy or otherwise 

gain access to the stream, whoever drinks the water may contract the 

disease. This is well illustrated by the epidemic which occurred in 

1885 in the town of Plymouth, Pa., with a population of about 8,000, 

at which time 1 of everv 8 inhabitants contracted the disease. Pose- 

%/ 

nau states: 

Plymouth received its water from a mountain brook which drained an 
almost uninhabited watershed. The stream was damned at intervals, and the 
water was stored in a series of four small impounding reservoirs. The source 
of the infection was traced to a citizen who spent his Christmas holidays in 
Philadelphia and returned home in January. He contracted typhoid; the 
excreta were not disinfected, but were thrown either into the frozen creek 
or upon the banks within 25 or 30 feet of the edge of the stream. At this 
time the brook was frozen and remained so until spring. There came a 
thaw in March and the entire accumulation was washed into the brook and 
thence into the water main. Three weeks thereafter cases of typhoid by the 
score made their appearance throughout the town. On some days more than 
100 new cases occurred. In all 1,004 cases were reported. Some estimates 
placed the number at 1,500—that is, 1 in every 5 of the inhabitants. There 
were 114 deaths. The epidemic was limited to the houses supplied with the 
town water or to persons who drank of the public water supply. The distinc¬ 
tion was particularly emphasized on one street, where the houses on one side 
had one or more cases while the houses on the other side had none at all. The 
former were supplied by the town; the latter depended upon wells. 

This epidemic will ever stand out in the literature as a clear-cut instance 
of water-borne typhoid caused by the quick transfer of virulent material from 
a single case. It proves further that freezing alone was not sufficient to 
destroy the typhoid infection, and on account of the coldness of the water it 
is exceedingly unlikely that any multiplication of the typhoid bacilli occurred. 
The infection, although greatly diluted, was nevertheless sufficiently virulent 
to induce the disease in most of those who drank the water. It further teaches 
the lesson how one person is sufficient to defile the “ pure waters of a mountain 
brook draining an almost uninhabited territory.” This epidemic was the first 
large outbreak in America where the cause was definitely traced to the water 
supply. It stands out sharply in the sanitary annals of our country on account 
of the lessons it taught and the good influence it had in stimulating other cities 
to safeguard and improve their water supplies. 

Many cities obtain water from rivers which are foul with sewage. 
Such water has to be purified before it can be safely used. This is 
done by storing it in large settling basins, where much of the mud 
falls to the bottom, carrying with it many disease germs and other 
impurities; from these basins the water passes through sand filters, 
which are shallow reservoirs having at the bottom about 6 feet of 


32 


PREVENTION OF DISEASE AND CARE OF SICK. 


filtering material. The top layer of this material is composed of 
about 3 feet of fine sand, which rests upon a layer of fine gravel, 
under which is a laver of coarser gravel covering a layer of broken 
stone. (Fig. 14.) The water flows from the filter through pipes 
which are placed in the bottom layer. While in the filter it is kept 
at a depth of about 3 feet above the sand. These filters if properly 
operated will remove over 99 per cent of the germs present in the 
water. The standard adopted by the Treasury Department for 
drinking water supplied to the public by common carriers in inter¬ 
state commerce, which should be the standard for all drinking water, 
requires that there be not more than 100 germs in 1 cubic centimeter 
(15 drops), nor more than 1 colon bacillus in 6 teaspoonfuls of 
water. The colon bacillus is a germ found in large numbers in the 
intestinal tract of warm-blooded animals, and its presence in water 
may be considered valid evidence that the water has been polluted 





with intestinal discharges of man or some of the higher animals. 
From 1.000,000 to 5,000,000 gallons of water can be purified each 
day by the above-described filter if it is an acre in extent. Other 
filters, known as mechanical filters, if of the same size, can purify 100 
times as much water in the time given. They consist of a tank con¬ 
taining a layer of sand through which the water passes after a small 
quantity (1 or 2 grains to the gallon) of alum or copperas has been 
added. These filters are useful where the water is very muddy, but 
they are more expensive to operate than the slow sand filters. Their 
action in removing germs is also not as uniformly high as the latter. 
Household filters are serviceable in rendering water free from mud, 
but no reliance should be placed upon them to remove germs. 

Bleaching powder, which is also called “ chloride of lime ” and 
“ chlorinated lime,’’ is often employed to purify water. This action 
of bleaching powder depends upon the calcium hypochlorite which it 




































PREVENTION OF DISEASE AND CARE OF SICK. 


33 


contains. This substance combines with tli$ carbonic acid in the 
water to form carbonated lime. The chlorine which is set free 
unites with the hydrogen of the water, and the oxygen thus liberated 
kills the germs in the water. A good bleaching powder will average 



Fig. 15.—A model well, cased with terra-cotta pipe, curbed 
with concrete, and provided with a water-tight platform 
and a pump. The water from such a well is unmixed with - 
surface water or filth. Properly located, such a well 
should furnish safe and healthful water. (Virginia 
Health P.ulletin, vol. 3, No. 4, 1911.) 

35 per cent of available chlorine. The quantity required to rid the 
water of germs varies from 1 to 3 parts of chlorine (3 to 9 parts of 
bleaching powder) to a million parts of water. This is a reliable, 
cheap, and efficient method of purifying water, except when it con- 





















































34 


PREVENTION OF DISEASE AND CARE OF SICK. 


tains a large amount of organic matter, when some preliminary treat¬ 
ment is necessary. Mud should be removed, as bleaching powder will 
not clarify water. When the bleaching powder is added in proper 
quantities, no unpleasant taste is perceptible in the water nor is any 
undesirable chemical compound formed in it. Large cities should 
place their main dependence upon sand filters, but the hypochlorite 
method may be resorted to as a temporary measure in case a supply 
pipe breaks or if for any other reason the filtering plant is put out of 
action. A few years ago, at Germantown, Pa., one of the main supply 
pipes leading from the filter broke, and it was necessary to furnish 
part of the town with raw water from the Schuykill River for a few 
days. Over 300 cases of typhoid fever occurred within a short time 
in the part of the city using this water. A year or so later a similar 
accident occurred and it again became necessary to furnish a portion 
of the city with raw water, but on this occasion the water was treated 
with bleaching powder, with the result that there was no increase in 
the number of typhoid fever cases over the number normally present. 

Where it is necessary to purify only a small quantity of water the 
solution is prepared by dissolving 1 teaspoonful of fresh bleaching 
powder in 1 quart of water. This should be placed in a tightly 
stoppered bottle and kept away from light. To disinfect water add 
1 teaspoonful of the disinfectant solution so prepared to each 2 
gallons of water, stir the water thoroughly, and allow it to stand 
for 15 minutes, when it will be ready for use. 

Persons living in the country and in small villages have to depend 
as a rule upon wells, springs, and cisterns for their water supply. 
Great care should be taken to prevent their pollution. 

The shallow well .—The well should be at least 200 yards away 
from a stable, privy, or hogpen. If these structures are on a slope, 
the well should be above them, never down hill from them, as the soil 
becomes polluted with filth, which may seep through the ground into 
it. The trough for watering stock, if one is required, should be 40 feet 
away from the pump and an iron pipe should be used to convey the 
water to it. The well platform should be higher in the center than 
at the sides so that water falling on its surface will drain off. This 
platform should be water-tight and have a raised rim and form a 
tight joint at the foot of the pump. The curb should be made of con¬ 
crete, brick, or masonry laid in cement mortar. It should rise 1 foot 
above the surface and extend 2 feet into the ground. It is important 
to have the casing water-tight so that no water can enter the well 
except that which comes through the bottom. Terra-cotta sewer 
pipe is the best material to use for this purpose. The joints should 
be held together with cement. The earth should be packed tightly 
around the casing. Sand should be used for this purpose, if it is 
available, as it is a good filter. 


PREVENTION OF DISEASE AND CARE OF SICK. 35 

The old-fashioned well bucket should not be used, as it may act as a 
vehicle to carry dirt into the well. This bucket is frequently set on 
the well platform, where it may be soiled by filth brought to the plat¬ 
form on the feet of a chicken or the sole of a shoe. The water becomes 
polluted with this material when the bucket is dropped back into the 
well. The bucket chain or rope may also be soiled by unclean hands 
when the water is being drawn up or the bucket is being emptied. 



Fig. 16.—A typical insanitary shallow well. Filth enters 
such a well through cracks in the platform, is washed into 
it by surface water through holes under the platform, 
seeps into it through the loose casing, and is carried in 
by the bucket or the rope soiled by filthy hands. (Vir¬ 
ginia Health Bulletin, vol. 3, No. 6, 1911.) 

Beef or artesian wells .—These wells are less liable to pollution, as 
the water is not drawn from the soil immediately adjacent to the 
well. The hardpan or rock through which the bore of the well 
passes prevents the deep water from becoming polluted by the sur¬ 
face water near the well. The places where this deep water falls 
upon the ground as rain may be a long way from the well and the 








































































36 PREVENTION OF DISEASE AND CARE OF SICK. 


ground through which it travels purifies it. This is the case in all 
instances except where the water has come through crevices in lime- 



Fig. 16a.—Heavy pollutions of the soil about the well from the privy, stable, and 
hogpen will in time overcome the natural purifying agencies of the soil and will 
seep through the ground into the well. (Virginia Health Bulletin, vol. 3, No. 6,1911.) 

stone rocks, as water may travel for miles through such spaces with¬ 
out being purified. 



Fig. 17.—Diagram showing pollution of wells in limestone soils. Surface water, 
heavily polluted, frequently disappears in a crevice in the limestone and may 
carry filth to wells and springs near at hand or long distances away. (Virginia 
Health Bulletin, vol. 1, No. 14, 1909.) 

A deep well may become polluted from the surface if the casing is 
defective or if it does not extend down to the hardpan or if the pipe 



































































































































































































































































































PREVENTION OF DISEASE AND CARE OF SICK. 




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38 


PREVENTION OF DISEASE AND CARE OF SICK. 


is not properly braced. If the pipe moves or rocks, surface water 
may flow down a channel along its sides and thus mix with the water 
at the bottom. 

Driven icells are good in sandy regions. Care should be taken to 
see that they are placed at a safe distance, fully 200 yards from the 
privy or barnyard. The well should be provided with a tight plat¬ 
form and the earth should be banked up around it. Dirty water 
should not be employed for priming the well, but only water that has 
been kept in a clean, covered bucket. 



L H- WILDER- 


Fig 19.—An insanitary privy of primitive type permitting 
extensive soil pollution. Reproduced from a photograph. 
(Original.) 



Fig. 20.—Covered can. The 
simplest type of sanitary 
receptacle privy. Used with 
a suitable drying powder, 
or disinfectant solution, it 
may be kept sanitary and 
practically odorless. The 
seat should be provided 
with cleats on the under 
surface to hold it in place 
on the can. (Original.) 


Springs should be inclosed in a brick or cement box with an outlet 
pipe so arranged that the water may run into a bucket placed beneath 
it. This arrangement prevents contamination of the spring by dip¬ 
ping the bucket or cup into it. The spring should have a ditch run¬ 
ning around it on the upper side to carry off the surface water, as this 
water, if allowed to flow into the spring, may carry filth and dirt 
with it. Xo water from a spring should, of course, be used if the 
spring is situated on a slope below a stable, insanitary privy, or pig¬ 
pen, as the water may be polluted by filth wdiich seeps through the 
ground from such places. 





































































PREVENTION OF DISEASE AND CARE OF SICK. 


Cisterns should be water-tight, as cracks may admit polluted 
water from the ground. They should have water-tight covers to 
keep out dirt and also to prevent mosquitoes from breeding in them. 
After a dry spell the first washing from the roof should not bo 
allowed to run into the cistern, as it contains dust and dirt which 
has accumulated on the roof since the last rain. 

Sewage Disposal. 

It is important that the discharges from the human body should 
be removed from the premises as speedily as possible. A water- 



Fig. 21.—The boxed receptacle. Flies are excluded bv the 
fly-tight box. Ventilation is provided by screened openings 
in the sides of the box and in the lid. The hinged front 
permits ready removal of the can for cleaning. Such a 
device is safe, sanitary, and convenient, and may be placed 
in an existing privy house or in any suitable outbuilding. 

(Original.) 

closet connected with a sewer affords a means of disposing of human 
waste which has many advantages over the privy or cesspool. As 
the former is usually placed in a heated room a person using it does 
not become chilled, as is frequently the case when he has to go out¬ 
side to a privy. The sewer removes the material to a distance and 
prevents contamination of the soil and its conveyance by flies to food. 
It is advisable that all buildings be provided with a water-carriage 
system, but it is. especially important that this be the case in towns 
having a population of over 3,000. 

In thicklv settled sections of the countrv the sewage should be 
given some preliminary treatment to render it less dangerous before 






























40 


PREVENTION OF DISEASE AND CARE OF SICK. 


it is emptied into a river or lake. There are a number of ways of 
doing this, among which may be mentioned the spreading of the 
sewage over the surface of the ground at a location which will not 
render it objectionable to the inhabitants of the city; it may also 
be treated by means of a sand filter in the same manner as water; 
or if the ground is of sandy formation it can be spread upon the 
ground and allowed to soak into the soil; trickling filters may be 
used by which means the liquid sewage is sprayed over rocks and 
thoroughly exposed to the air, the. purified sewage running oif 
through drains at the bottom of the pile of rock. T\ hen there is a 
large quantity of trade waste in the sewage, sedimentation may often 
have to be used, lime, copperas, or alum being employed to hasten 
the precipitation. Large settling tanks may be employed in which 
the sewage is allowed to remain from 8 to 24 hours, during which 

time some of the solid 
substances undergo 
liquefaction. From this 
tank the liquid sewage 
flows over rock, laths, 
or other rough surfaces 
whereby it comes in 
contact with the air. 
Sewage may also be 
disinfected, after it has 
been subjected to the 
action of the air, by the addition of bleaching powder, but this is 
not often necessary, as it is not intended to free it entirely of bac¬ 
teria but onty of a large percentage. 

The efficiency of the various methods described above is given by 
Whipple as follows: 



Fig. 22. —Modes of spread of typhoid fever, dysen¬ 
tery, and Asiatic cholera from person to person. 


Method: 

Septic sedimentation_ 

Chemical precipitation. 

Trickling filters_ 

Sand filters_ 

Spreading on sandy soil 


Percentage 
removal of 
bacteria. 

_ 25-75 

— 40-80 
... 90-95 
... 95-98 
___ 97-99 


Plumbing. 


Sewer air is objectionable in the same manner as any impure air 
would be, but the old idea that many diseases are contracted through 
sewer air is no longer considered tenable as the danger of contracting 
these diseases bv breathing this air is extremely small. Sewer pipes 
leading into a house should have a trap at the connection of the 
house drain with the street, and in such cases it is questionable 
•whether it is necessary to have other traps in the building. The 






















PREVENTION OF DISEASE AND CARE OF SICK. 


41 


system of traps and vents now in use is unnecessary, and the plumb¬ 
ing of the future should be developed along simpler lines, thereby 
saving expense to the builder without loss in efficiency. 

Privies . 1 

In rural districts and in small towns which have no water-carriage 
system, privies should be used to dispose of the discharges from the 
human body. If a privy is properly constructed, intelligently used 
by all members of the family, kept in repair, and the contents re¬ 
moved at regular intervals and deposited in a safe place, the water 
supply will not be contaminated and flies and other insects will not 
carry disease to persons living in the home or in the neighborhood. 
The privy should be screened, should be provided with an automati¬ 
cally closing lid over the opening in the seat and should have a water¬ 
tight receptacle to receive the discharges, arranged so as to he easily 
removed or cleaned. 

The following types of privies described in the publications of the 
Public Health Service conform to the principles of sanitation and 
have proved in actual use to be practical. 

Covered can .—This is simply’a can with a closely fitted wooden 
top, having a suitable hole covered by a hinged screened lid. 

Boxed can .—In this type the receptable is inclosed in a box with a 
suitable hole in the top, covered b}^ a lid. The top or side should 
be hinged to permit the taking out of the receptacle for emptying. 
The box should be somewhat larger than the receptacle in order that 
its removal may be easily effected. The receptacle may be placed in 
the back of a privy, if it is so desired, and the space around it boxed 
up with a screen door at the back. Such an arrangement keeps the 
discharges off the ground and prevents flies from breeding in or 
feeding on them. The hox should he well ventilated either by 
screened openings or by a ventilating flue to remove objectionable 
odors. Lime, dry earth, and ashes may also be mixed with the feces 
for this purpose, a. cupful being placed on each stool immediately 
after it is deposited. 

The L. B. S. privy .' 1 —If human excreta are permitted to undergo 
natural fermentation, the solid matter becomes liquefied and a con¬ 
siderable proportion of the excrement and urine is carried away by 
evaporation and gas formation. Thus the labor and cost of dispos¬ 
ing of the matter may be lessened. These principles are applied in 
the L. It. S. privy. (Figs. 20 and 28.) 

1 See Appendix B, Note 1, ]>. 014. 

3 Lumsden, Roberts, and Stiles: '“Preliminary note on a simple and inexpensive appa- 
nitns for use in the safe disposal of night soil.” Public Health Reports 1910, Xov. 11. 
v 25 ( 45 ), pp. lGl'.'l-lOl'O. Stiles and Lumsden: The Sanitary Privy. Farmers’ Bulletin 
-4<;:; (U. S. Department of Agriculture), pp. 17-21. Lumsden: Public Health Bulletin 
No. 51, pp. 40-49. 




42 


PREVENTION OF DISEASE AND CARE OF SICK 



























































































































































































































PREVENTION OF DISEASE AND CARE OF SICK 


43 


This apparatus consists of the following parts: 

(1) A water-tight tank, barrel, or other container, to receive and 
liquefy the excreta. 

(-) A covered water-tight can, pot, barrel, or other vessel, to re¬ 
ceive the effluent or outflow. 



Fig. 24.—Rear and side view of a removable-receptacle sanitary privy. (Stiles, 1910.) 


(3) A connecting pipe about 24 inches in diameter, about 1*2 
inches long, and provided with an open T at one end, both openings 
of the T being covered with wire screens. 

(4) A tight box, preferably zinc lined, which fits tightly on the 
top of the liquefying barrel. It is provided with an opening on top 
for the seat which has an automatically closing lid. 















































































































































































































































































44 


PREVENTION OF DISEASE AND CARE OF SICK. 


(5) An antisplashing device, consisting of a small board placed 
horizontally under the seat about an inch below the level of the trans- 
verse connecting pipe. It is held in place by a rod, which passes 



Fig. 25.—A sanitary removable-receptacle privy made by building a 
fly-tight box under the seat of an open-in-back insanitary privy and 
by placing a water-tight receptacle in the box. (Original.) 


through a hole in the side of the seat and by which the board is 
raised and lowered. A layer of chips floated in the tank may be used 
instead of this antisplashing device. 

(6) A ventilating pipe, such as a stovepipe or wooden flue, con¬ 
necting the space under the seat with the open air. 



direct distribution of effluent into top soil. (Original.) 

The liquefying tank is filled with water up to the point where it 
begins to trickle into the effluent tank. A pound or two of old 
manure should be added to the water to start fermentation. As an 
insect repellent a film of some form of petroleum may be poured on 
the surface of the liquid in each container. 



















































































PBEVENTION OF DISEASE AND CABE OF SICK. 


45 


A\ hen the privy is to be used the rod is pulled up so that the anti¬ 
splashing board rises to within about 1 inch of the surface of the 
water. The fecal material falls into the water, but this board pre¬ 
vents splashing. Before leaving the privy the person should sink the 
antisplashing board by pushing down the rod so that the fecal mat¬ 
ter and the toilet paper will float free into the water. 

Although some of the fecal matter floats, it is protected both from 
fly breeding and fly feeding in the following ways: First, by the 
automatically closing lid; second, by the water; third, by the him of 
oil; and fourth, by having the apparatus located in a screened place, 
which should be done for additional safety. The film of oil prevents 
the breeding' of mosquitoes in the tank. 



Fig. 27.—A stationary-receptacle sanitary privy with a cement vault 
arranged for convenient cleaning. (Original.) 


The fecal material ferments in the water and gradually liquefies. 
Disinfectants must not be used in the liquefying tank because they 
stop the fermentation. When the level of the liquid is raised the 
excess flows into the effluent tank, where it is protected from insects 
by the cover and a film of oil. The effluent may be allowed to collect 
in this tank until it reaches the level of the connecting pipe, when it 
may safely be disposed of in an} 7 one of the following ways: 

Burning .—In cities, towns, and villages privy contents may be 
disposed of most conveniently, most safely, and most economically 
by burning with other refuse in an incinerator. At country homes 
also disposal b}^ burning is the safest method; but because of lack of 
facilities at such homes it is usually not feasible. 

Discharge into a sewer .—If a sewer is available, privy contents may 
be dumped through a manhole directly into it and the sewer flushed 
with water from a fire hose. In doing this precautions (grit cham- 
49671°—23-4 
















46 


PREVENTION OF DISEASE AND CARE OF SICK. 


bers or gratings) should be used to prevent choking of the sewer 
with coarse insoluble matter. From a sanitary standpoint, the 
diluted privy contents are as safe for discharge through the sewer as 
is the sewage of the community. 

Burial .—In small villages and country communities the disposal 
of privy contents by burial is usually the most available method that 
is practicable. The place selected for burial should be at least 100 
yards away from any water supply and should not drain toward it. 



To take advantage of the natural agencies of purification in the 
soil and to protect underground sources of water supply as much as 
possible, the burial should be in the upper 2 feet of the soil. Fur¬ 
rows (such as are made by an ordinary plow) or narrow trenches 
should be used rather than large pits, so that the purifying agents 
of the soil will not be overworked. As an additional safeguard, dis¬ 
infection of the excreta by heat or chemicals may be employed before 
such burial. 

The effluent from the L. R. S. privy is particularly adapted to 
disinfection. If human excreta are disinfected by boiling, the matter 
is safe for use as a fertilizer, even near the dwelling. 



















































































PREVENTION OF DISEASE AND CARE OF SICK. 


47 


The field used for the burial of untreated excreta should be one 
which is not to be cultivated for at least 6 months; and in sections 
where hookwmrm disease prevails a minimum of 12 months should 
be allowed. In cold climates trenches should be dug before the 
ground freezes. They should be ample to take care of. privy con¬ 
tents during the winter and should be marked with stakes, so that 
they may be found even when covered with snow. The matter put 
into these trenches should be covered as soon as the ground thaws. 
Trenches for winter use should be about 2 feet deep. In open weather, 
the matter should always be covered immediately; the furrows should 
be from 6 to 12 inches deep; and the excreta scattered along the 
furrow, in a laver not more than 2 inches in thickness, and covered 
with 6 to 12 inches of earth. 



Fig. 29.—Distribution of effluent from an L. R. S. privy into top soil. The 
effluent pipe is cemented into a glazed (water-tight) terra cotta pipe which ex¬ 
tends to the disposal ground. The effluent is distributed into the soil by means 
of open-joint drain tile. (Original.) 

The use of a field for the burial of human excreta in this manner 
increases the fertility of the soil. This is particularly the case if the 
matter is given as much as 12 months to undergo thorough rotting. 

The effluent from an L. K. S. privy is more readily purified by 
the natural agents of the soil than are crude excreta. It is liquid, 
and its volume is relatively small. It is therefore v T ell adapted for 
direct disposal into the active subsurface soil. (Fig. 26.) The place 
selected for such disposal should be well aw T ay from (at least 50 
yards) and not draining toward any water supply. The effluent 
may be conveyed under ground through a water-tight pipe for the 
necessary distance and then distributed into the soil by means of 
drain tiie. The tile should be laid about 12 inches below the surface 
of the ground. If the soil is not porous, the distributing pipe may 
be laid in a trench filled with sand or gravel. The increased fer¬ 
tility of the soil along the track of the distributing pipe may be used 
advantageously to cultivate an attractive hedge of rose bushes (fig. 

















48 


PREVENTION OF DISEASE AND CARE OF SICK. 


29) or other shrubs or to cultivate a row of corn or other plants, the 
edible parts of which are produced well above the surface of the 
ground. 

Disposal of Refuse. 


There are two methods of disposing of refuse generally in use in 
cities—the mixed system and the separate system. In the “mixed” 
system ashes, waste paper, garbage, and all sorts of rubbish are 
placed together in one can and removed several times a week to an 
incinerating plant where it is burned. The combustible matter in 
the refuse is usually sufficient to evaporate the water in the garbage, 
so that the material is self-consuming and requires but very little 
additional fuel. Steam generated by the heat may be employed to 
heat buildings or to run power plants for the use of the city. As 
the garbage is mixed in with ashes and other waste materials in this 
method there is less odor and it is not liable to attract flies and 
mosquitoes. 

When the “ separate “ system is used the ashes and other rubbish 
are kept in separate cans from the garbage. There should always be 
two cans for the latter, one to be washed and allowed to dry while 

' t 

the other is being used. Special care should be taken to see that the 
cans have tight-fitting covers, so that the garbage may not be a 
source of food for rats or a breeding place for flies and mosquitoes. 
In large cities this garbage, after being collected, is often taken to 
a reduction plant, where the grease is saved for the extraction of the 
glycerine and for making soap, while the solid material, known as 
tankage, is utilized as a filler for fertilizers. 


Cleaning. 

Buildings which are inhabited by human beings should be kept 
scrupulously clean, and in cleaning great care should be exercised 
to avoid the stirring up of dust, the bad effects of which have already 
been pointed out in connection with the ventilation of buildings. 
(See p. 19) Wooden floors of living rooms should be varnished or 
waxed and polished so as to present a hard glistening surface. Only 
the best quality of varnish should be used, as the cheaper grades are 
sticky and gather dust. The cracks of old floors should be filled, after 
which the floors should be planed or sandpapered and then varnished 
or waxed. Carpets give a homelike appearance to rooms, afford some 
protection from cold, deaden the sound, and, on account of their 
elasticity, are comfortable to the feet, but they are great collectors 
of dust and dirt and are therefore insanitary. They are also difficult 
to keep clean and favor the development of vermin. On account of 
these disadvantages many persons have given up the use of carpets. 


PREVEXTTOX OF DISEASE AX^D CAEE OF SICK. 


49 


Rugs are less objectionable, as they can be easly removed and cleaned 
on the outside of the building. Matting that is tacked down should 
never be employed, as large quantities of dust will collect beneath it, 
which is diffused in the air by persons walking across the floor. 
Kitchen and bathroom floors, and halls where marble is used, should 
be frequently scrubbed, using plenty of soap and water. Cement 
floors should be kept painted, as otherwise the} 7 give off a fine dust. 
Linoleum is very useful in kitchens and the halls of large buildings. 
It should be carefully laid, the floor first being thoroughly cleaned, 
a cement paste put on the floor, and the linoleum then carefully fitted 
in place. Heavy weights should be placed along the seams. If the 
linoleum is put down in this way no water will get beneath its sur¬ 
face. and it makes a very satisfactory covering for the floor, as it can 
be easily cleaned with a little soap and water. Calcimining should 
not be employed except in cellars and for outbuildings, as w T alls thus 
treated can not be cleaned without streaking the dust over the sur¬ 
face. Painting is the best treatment for walls; wall paper is ob¬ 
jectionable because it is difficult to clean. 

Great care should be exercised in cleaning a house to prevent the 
dissemination of dust. It is of no value to stir up the dust in a 
room, simply brushing it off of one place and letting it settle in an¬ 
other. For this reason dry sweeping and dusting should not be 
employed. Carpets should be cleaned with carpet sweepers or 
vacuum cleaners, and if necessary to use a broom the carpet should 
be taken out of the building, or, if this is impracticable, the windows 
of the room should be thrown wide open so that there will be a 
circulation of air to blow 7 the dust out. A person using a broom in 
this way should have a piece of cheesecloth tied over the face to 
prevent, as far as possible, the inhalation of dust. Polished floors 
should be cleaned with woolen floor dusters. (See fig. 30.) Tlx 
dust sticks to these woolen brooms and is not scattered about the 
room as when a corn or hair broom is employed. The wool can be 
cleaned by washing it in hot soapsuds; after drying, it should be 
dipped in kerosene oil and permitted to dry again without wringing. 
Another method of treating these brooms is to place them in gaso¬ 
line, to w 7 hich an ounce of floor oil has been added to each quart. 
These brooms can now be purchased on the market prepared for 
use. If the floor is very dirty a hair broom shoidd first be used 
with a sweeping compound, the latter usually consisting of sawdust 
or paper moistened with a little water or oil. The dust sticks to the 
saw 7 dust and is thus prevented from being blowm about the room. 
Walls should be cleaned with soap and water and frequently dusted 
with one of the wool dusters described above. Feather dusters and 
dry cloths should never be used for removing dust from furniture as 


50 


PREVENTION OF DISEASE AND CARE OF SICK. 


these articles scatter the dust as badly as corn brooms when sweep¬ 
ing the floor. Wool dusters with short handles (fig. 31) or cloths 
treated with kerosene or gasoline in the same manner as the wool 
floor dusters are prepared are the best for this purpose. 


TRANSMISSION OF DISEASE BY INSECTS. 

Flies. 



There are many kinds of flies, the most important in this country 
being the house fly. Among others may be mentioned the blue-bottle 
fly, the green-bottle fly, the stable fly (which is a biting or blood¬ 
sucking fly), the cheese fly, the lesser or small house fly, the fruit 
the sand fly, and the tse tse fly (also a biting fly, a native of South 
Africa, which causes the disease known as sleeping sickness). 

The house fly is found in nearly all parts of the world, but seldom 
in places where there are no human habitations. It consists of a 

head, thorax, and abdo¬ 
men. In the head are 
several thousand eyes. 
It is believed, however, 
that it depends more on 
its sense of smell than 
its vision in finding its 
food. It sucks its food 
up through a tube, 
called a proboscis, at- 

Fig. 33. —Side view of blow-fly (Calliphora cry thro- tached to the Under 

cephala ) (X 5). A, Cheek (jowl); B, squama; portion of tile head. 

( , halter. rpi . 

I lie wings are fastened 
to the thorax. There are three pairs of legs covered rather 
thickly with coarse hair. The breeding season in the North 
is from May to October, while in the South it begins as early 
as March. The eggs are deposited in batches in fresh horse 


manure, kitchen refuse, decayed vegetables, human excreta, putrify- 
ing animal matter, or any other kind of organic filth. In such 
substances the proper temperature, moisture, and food for fly 
propagation is found. Their number increases very rapidly, as a 
fly is fully developed in 8 or 10 days after birth, and each female is 
capable of laying 100 or more eggs. The eggs are smooth, white, 
glistening bodies. Under favorable circumstances thev are trans- 
formed into larvae or maggots within 1*2 hours. These reach ma¬ 
turity in from three to six days and leave the substance in which 
they are hatched and burrow into the ground or travel several feet 
along its surface. A contraction of the maggot now occurs; it 
changes to a dark color, and is known as a pupa. In this stage the 






PREVENTION OF DISEASE AND CARE OF SICK. 


51 


wings and other structures of the full grown insect attain their full 
development, and in about three days the adult fly breaks through 
the sack and escapes. 

Substances intended for human consumption should be protected 
from house flies, as these insects may carry the parasites or micro¬ 
organisms of disease on their bodies, especially on their wings and 
hairy legs, from privies and other places where such agents abound. 
Solid food is contaminated by their crawling over it, and liquids by 
their drinking it or falling into it. Flies also have a habit of re¬ 
gurgitating their food after it is swallowed and smearing it on arti¬ 
cles over which they crawl. (Fig. 35.) As this material may have 
come from privies, cuspidors, or other places where disease germs 
may be present, it is evident that these germs may be left on food or 
in drink with which the flv comes in contact and cause disease in the 
person swallowing it. The same germs may also pass through the 
fly’s body and be deposited as part of its excreta on food, and thus 
gain an entrance into the human body. 

Among the diseases which may be transmitted by the house fly are 
typhoid fever, diarrhea, dysentery, cholera, and probably tubercu¬ 
losis, diphtheria, and scarlet fever. It is also believed that the eggs 
of intestinal worms, such as tape worms, hook worms, and round 
worms, may be carried to human beings by flies. 

Eradicative measures. —Lizards, toads, spiders, and wasps are the 
natural enemies of the fly. ' Beetles, ants, and birds feed on both 
larvae and pupae. These animals, however, make but slight inroad 
upon the fly population. There is a disease which attacks and kills 
great numbers of flies late in summer; it is caused by a fungus which 
invades the body and destroys the vital organs. It is more preva¬ 
lent from August to October, and accounts to some extent for the 
decrease in the number of flies at this time of year. 

In order to eradicate the fly it is necessary to do away with its 
breeding places. Privies must be screened so that flies can not get 
into them. Garbage must be kept in covered containers until it can 
be burned or buried, and fresh horse manure must be removed from 
the premises at least every four days, as but four days are required 
from the time the eggs are deposited until the maggots begin to mi¬ 
grate from the manure heap into the ground to continue their devel¬ 
opment into full-grown flies. M. E. Roubaud states: 

Frcsli manure alone plays a part in tlie production of flies. The laying of 
eggs even takes place in the stable on the dung impregnated with urine. Ovi- 
position may continue for 24 hours, but never later. Fermentation, after 
barely 24 hours, definitely protects the manure from the laying of eggs. Anti¬ 
septic substances and larvicides (borax, cresol, ferrous and ferric salts), by 
delaying fermentation, may prolong deposition one or two days. Employed as 
larvacides, these substances, by prolonging the period of infestation, often 


52 


PREVENTION OF DISEASE AND CARE OF SICK. 


produce a result the very opposite of that intended. From the sixtli day 
manure when placed in a heap does not contain larva, these having migrated 
to the base for nymphosis. Antifly measures, therefore, ought to be taken 
within five days of the removal of the manure from the stable. Manure 24 
hours old at the time of the removal does not contain visible larvae. The 
eggs which are disseminated throughout the manure heap then open and 
the larvae come to the surface, leaving the central parts as fermentation de¬ 
velops and the temperature rises. On the following day a temperature of 70° C. 
to 90° O. (158° F. to 194° F.) may be found in the center of the heap. The heat 
arising from fermentation in a manure heap may be used as a means of destroy¬ 
ing the larvae which it contains. The larva of the domestic fly, protected from 
the gases of fermentation, dies in three minutes when exposed to a temperature 
of 50° C. (122° F.). In contact with the gases it dies in one minute at 91° C. 
(123.S 0 F.), in five to seven seconds at 59° C. (138.2° F.), and four to five sec¬ 
onds at 60° C. (140° F.). 

When a manure heap is turned over the larvae which come in contact with the 
hot parts in the interior are killed at once. A complete stirring up of the 
manure on the day after the deposition, and repeated on the two following 
days, causes a disappearance of 90 per cent of the larvae. This operation is 
more easily and quickly done if, instead of waiting until the infected heap has 
itself produced the necessary temperature, it is exposed to the heat of a heap 
previously fermented. For this purpose, instead of placing the new manure 
on the surface of the heap as is usually done, it should be buried in the hot 
parts by covering all its surfaces with a layer of hot manure 20 centimeters 
thick. In four or five hours the new manure may be considered as entirely 
free from eggs and larvre, which would otherwise have developed in thousands. 
This biological method of delarvization by heat is equivalent to the heating of 
the whole of the fresh manure to a temperature of 50° C. (122° F.) to 00° C. 
(140° F.), and is effected without apparatus and without fuel. It is within the 
reach of all, and only a simple training of the personnel is required. In prac¬ 
tice it is found that the mass of fermented manure required to furnish the 
necessary temperature is about eight times that of the fresh manure to be 
. treated. Next day this may be used in its turn as a source of heat. The 
biothermie method of treating fresh manure can alone destroy quickly and 
cheaply the eggs and larvae in a manure heap. 

“ Swat the fly ” campaigns will not eliminate flies unless other 
measures are taken. They do more good in the earh T part of the 
season. Dwellings, markets, and bakeries should nlwavs be carefully 
screened, and where it is not possible to screen the buildings food 
supplies should not be exposed unless they are protected by netting. 
Large flytraps, placed in localities where flies are abundant, have 
been found to be useful in diminishing their number. Various forms 
of these traps are used, one of which is shown in figure 88. Howard 
states that— 

Manure boxes with flytraps attached (see fig. 39) should be used by all 
stock owners in towns and cities, and they are also adaptable to farms. The 
size of the manure bin should be governed by the individual needs, but for use 
on the farm it is desirable to make it large enough to hold all of the manure 
produced during the busiest season of the year. A box 11 feet long, 10 feet 



Fig. 32.—The house fly. 



Fig. 34.—Mass of larvfe in stable manure. (After Graham-Smith.) 



















Fig. 35.—House fly regurgitating liquid material. (After Hewitt.) 



Dirtiest &nd mc6t daneferpus 
9f all heuse vermin 

Distributers y/ilth &od §ero?5 
9 / Disease 

<rf=v lies 

» OLLOW 
ii l LTAl 

r E V ■ t R 5 
OLLOW 
LIES 

do? W ATT1/S G 
v '0 ! AVEi 

I C icm bd 

The. m9i>telective, waq tc 151•? 

destroy W*»r breeding places Keep manure, 
garbage and ctbenwaStea covered and 
have fnese removed /reqtwniiu‘-Screer; 
the pnvu Clean up and keep clean 

FLIE6 f/S-THE hQnt INDICATE* 
A DIRTY OR CARELE# HOUSEWIFE. 


Tr mo is. 




y * \ 

V h 

•S), 

■ >; 

k> . ' |. 

*] 

'} ’ 

' ^ f 

t 

i 

}: 

j 



> 


Fig. 36. —By courtesy of the Chicago Health Department. 

































PREVENTION OF DISEASE AND CARE OF SICK. 


53 


wide, and 4 feet deep will hold the manure produced by two horses during about 
five months. About 2 cubic feet of box space should be allowed for each 
horse per day. The bin should be made of concrete or heavy plank. When the 


latter is used the cracks should be battened to prevent the escape of Hies. The 
bin may have a floor or it may be set in the ground several inches and the dirt 
closely banked around the outside. For the admission of the manure a good- 
sized door should be provided in either end of a large bin. A portion of the top 


should be made easily removable for convenience in emptying the box, or one 


entire end of the box 
may be hinged. On ac¬ 




count of the danger of 
the door being left open 
through carelessness, it 
is advisable to arrange 
a lift door which can be 
opened by placing the 
foot on a treadle as the 
manure is shoveled in. 
The door should be 
heavy enough to close 
automatically when the 
treadle is released. 


In buildings where 
flies are not very 
abundant, sticky flv 
paper is fairly effi¬ 
cient in reducing 
their number. A so¬ 
lution containing 
t li r e e teaspoonfuls 
of sodium salicylate 
in one pint of water 
may be placed in 
saucers around the 
room, and it will be 
found that many 
flies will be killed 
by drinking thereof. 

It is necessary, how- 

/ 

ever, to remove other 


Fig. 38.—Conical hoop flytrap ; side view. A, Hoops form¬ 
ing frame at bottom. B, Hoops forming frame at top. 
Cj Top of trap made of barrel head. D, Strips around 
door. E, Door frame. F, Screen on door. G, Buttons 
holding door. H, Screen on outside of trap. I, Strips 
on side of trap between hoops. J, Tips of these strips 
projecting to form legs. K, Cone. L, United edges of 
screen forming cone. M, Aperture at apex of cone. 
Bisbopp. 

liquids from the room. Care should be taken 


to see that children and animals do not drink the water, as 


sickness may result therefrom. This solution may be placed in a 
tumbler and the latter inverted over a piece of blotting paper in a 
dish. The solution gradually oozes through the blotting paper 
upon which the Tumbler rests and thus becomes accessible to 
the flies. 





































































































































54 


PREVENTION OF DISEASE AND CARE OF SICK. 


Mosquitoes. 

Most mosquitoes lay their eggs upon the surface of water. In 
some species these adhere together in raft-like masses. In summer 
time the larvae, or u wiggle tails," hatch in one or two days. Al¬ 
though they live in water, they must, with the exception of one 
unimportant species, either lie on its surface or come frequently to 
the surface to breathe. In a few days the larvae change into pupae, 
or “ tumblers,” from which the winged insect emerges through a 
rent in the pupa*case and flies away. The whole process, from the 



laying of the egg to the emerging of the adult insect, requires from 
9 to 15 days, or. if the water is cold, sometimes as much as 22 cla} T s. 
Some species hibernate in the egg form. 

The different parts of an adult mosquito are shown in figure 42. 
There are a number of species of mosquito, each ying slightly 
from the other. Only female mosquitoes are blood-sucking insects; 
male mosquitoes are vegetarians and do not bite man or animals. 
For some species blood appears to be necessary to the female mos¬ 
quito for the full development of its eggs. 

The breeding places of mosquitoes depend to a great extent upon 
the species. The yellow-fever mosquito and the domestic mosquito 































































Fig. 37.—Mass of eggs of house fly, M. domestica. (From 
Gordon Hewitt.) 


* v 7 


' , - v <- 

I 


vv*-r* 


Fig. 40.—Mosquito “ wigglers;” larvae and pupae in the water. 

Life size. 


























Fig. 43.—Anopheles maeulipennis (quadri- 
maculatus), female. (Castellani and 
Chalmers, after Austen.) 



Fig- 44.—Aedes calopus, male. 



Fig. 45.—Aedes calopus. female. 



Fig. 45.—Culex pungens, male. (After Howard.) 





Fig. 47.—Culex pungens. female. (After 
Howard.) 















PREVENTION OF DISEASE AND CARE OF SICK. 


55 


breed around houses, in any small collection of water that may be 
present in tin cans, bottles, flowerpots, pools, gutters, sewers, etc. 
Malarial mosquitoes may be found breeding in such places, but this 
mosquito usually prefers the margins of ditches and lakes, es¬ 
pecially where reeds and water plants are found, as in swamps and 
low bottom lands. Near the seacoast there are other mosquitoes 
which breed only in brackish water, but these, although annoying, 
do not transmit disease to man. Mosquitoes may be blown many 
miles by the wind, but it is not usual to find those that transmit dis- 
ease very far from their breeding places. The presence of mos¬ 
quitoes in a house is good evidence that they are breeding in some 
place near the house, and very often a search will be rewarded by 
the finding of wiggle tails in some small collection of water. They 
are often carried by trains and boats for long distances, and the 
spread of yellow fever from one country to another is accounted 
for to a great extent by infected mosquitoes being carried in this 
way. During the winter some species of mosquitoes hibernate in 
cellars and dark cor¬ 
ners; in others, the 
larvae or eggs resist 
cold, and they even 
hatch out after be¬ 
ing frozen. 

The diseases known 
to be transmitted by 

. Fig. 64.—The effect of mosquito eradication in Habana on 

mosquitoes are ma- yellow fever (right) and malaria (left). 

laria, yellow fever, 

dengue, and filariasis. Three conditions are necessary before these 
diseases can be spread from one person to another. First, a person 
must be bitten by a certain kind of mosquito—malaria is only trans¬ 
mitted by Anopheles mosquitoes; yellow fever by a striped black 
and white mosquito called Aedes calopus; a mosquito known as the 
Culex fatkjans , and probably some others, are believed to carry the 
germs of dengue ; while filariasis is spread by several varieties of 
mosquito. Second, the mosquito must have been infected by pre¬ 
viously biting some person who has the germ of the disease in his 
blood. Third, some time, varying with the different diseases, for 
some not less than 8 or 10 days, must elapse between the time the 
mosquito bites the person suffering from the disease and the biting 
of the well person. The reason for this, in the case of malaria, is 
explained by Surgeon Carter as follows: 

. If the mosquito sucks up only sexless parasites with the blood she will not 
become infected, no matter how many she takes. If. however, the proper kind 
of mosquito takes up the male and female forms of the parasite they join to¬ 
gether in her stomach and pass into her stomach wall, where they grow. After 
some time the bodies thus formed break and set free many young parasites, 







56 


PREVENTION OF DISEASE AND CARE OF SICK. 


some of which finally find their way to the mouth of the mosquito. There the 
parasites are mixed with her saliva and are injected into a man When she 
bites him; then they enter the blood cells and start their life all over again. 

Eradicative measures .—As it is impossible to tell, except by careful 
examination, which mosquitoes are capable of conveying diseases to 
man, it is necessary that measures be taken not only to diminish the 
number of mosquitoes but also to prevent them from biting persons, 
so far as it is practicable to do so. It is especially important that 
mosquitoes should not be allowed access to a person suffering from a 
disease which may be conveyed by them, as one of them may become 
infected by biting the sick person and thus transmit the disease to 
others. The subject of the eradication of such diseases, therefore, di¬ 
vides itself into two portions—the first is the protection of the body 
from the mosquito, and the second the elimination of breeding places 
or such treatment of them as will render them unsuitable for that 
purpose. 

All buildings at places infested with mosquitoes should be 
screened. A description of the methods used for this purpose will be 
found on page 18. The house should be searched each morning for 
mosquitoes which may have gained entrance through cracks and 
other places not properly protected, as otherwise the house becomes a 
mosquito trap: the mosquitoes simply hide, and during the night 
attack the people dwelling therein. 

No water should be allowed to stand in containers around the 
dwelling. Empty cans and bottles in which rain water may collect 
at any time should be taken away. The grass should be cut short in 
order that it may not serve as a hiding place for mosquitoes, and a 
screen of trees should be planted some distance from the house be¬ 
tween it and any mosquitoe breeding place, such as a lake or swamp, 
that may be near by. Low places in the ground should be drained by 
ditches. Open ditches should be made with sufficient fall to prevent 
the collection of small puddles of water in the bottom; it is best tc 
line them with cement. In many places subsurface drains may be 
employed (fig. 62), in which the drain is put in the ditch after it is 
dug and the ditch then filled with loose rock. Cisterns and rain 
barrels must also be screened or a film of oil must be kept upon their 
surface. The oil prevents the wiggle tails from coming to the 
surface to breath. The reeds and plants around the edge of streams 
and lakes should be cut away, in order to allow fish, which feed upon 
the larvae of mosquitoes, to gain access to them. Streams not having 
fish should be stocked with the kinds that feed on the larvae, a little 
fish known as the kilifish or any kind of “ top minnow *' being es¬ 
pecially valuable for this purpose. 

Oil may be used as a temporary measure to prevent the breeding 
of mosquitoes. It should be spread as a fine film over the surface 



Fig. 41.—Dipping water from a 
rain barrel to look for mos¬ 
quito larvae. 



Antenna 


F^noiaB 1 ^ 


-Met^arsu 


*■_' 1st Sub-marginal cell. 
fejSf.it V«*t«rtos* 

feSjtem uf ist .wb-rn j'&inal * ell 
rn, s,uptrtj itmtrijit y. ‘t. rods- . <i n, 
K.MW erb\ wein 
gt Posterior cross vein 
fejt$ctitrUuin. 


Ungu?i 


Fig. 42.—Diagram of mosquito, showing parts. 
Note.—The part of the leg marked Y ‘meta¬ 
tarsus” is in reality the first tarsal joiut; both 
terms are used. 



Fig. 59 .—A is a mosquito larva; B is a pupa; C is an 
adult mosquito coming out of an old pupa. 

41)071 °—2:5--.1 + 0 





























Fig. 48.—Normal red blood cells. Fig. 50.—Resting posture of mosquitoes: 1 and 2, Anopb- 

andred blood cells containing " eles; 3, Culex pipiens. (After Sambon.) 

malarial parasites. 




Fig. 49.—Heads of mosquitoes: 1 and 2, male 
and female Culex pungens; 3 and 4, male 
and female Anopheles; 5 and 6, male and 
female Aedes calopus. (After Stitt.) 


Fig. 51.—Anopheles maculipennis (quad- 
rimaculatus), male. (After Castellani 
and Chalmers.) 
















PREVENTION OF DISEASE AND CARE OF SICK. 57 

of the water, a light oil being best adapted for this purpose. In a 
slow-running stream oil may be used by allowing it to drip slowly 
from a container placed at the source of the stream. It requires 
about an ounce of oil for each 15 square feet of surface, and the oil 
has to be renewed several times a month. The oiling of streams to 
prevent breeding of mosquitoes is not very satisfactory, as wind will 
often blow the oil to one side and leave a large surface of the water 
free for breeding purposes. In Panama a better result was obtained 
by using a larvicide, which was made as follows: One hundred and 
fifty gallons of crude carbolic acid having a specific gravity not 
greater than 0.97 and containing not less than 30 per cent tar acids, 
is heated in an iron tank with a stream coil to a temperature of 212° 
F., then 200 pounds of powdered or finely broken common resin is 
poured in. ' The mixture is kept at a temperature of 212° F. Thirty 
pounds of caustic soda dissolved in 60 gallons of water are then 
added, and the solution is kept at the same temperature until a per¬ 
fectly dark emulsion without sediment is formed. The mixture is 
thoroughly stirred from the time the resin is added until the end. 
One part of this emulsion to 10,000 parts of water is said to kill 
Anopheles larvae in less than half an hour, while 1 part to 5,000 
parts of water will kill them in from 5 to 10 minutes. The Panama 
larvicide is mixed with 5 parts of water and sprayed upon pools or 
along the banks of streams. This larvicide added to 5 parts of 
crude petroleum favors its spread upon the surface of the water. A 
good method is to place the mixture in a barrel and permit it to 
drip upon the surface of the stream or pond to be treated. 

Senior Surgeon Carmichael advises the use of pine tar and castor 
oil to prevent attacks of mosquitoes. One ounce of pine tar is thor¬ 
oughly mixed with 6 or 8 ounces of castor oil, and then applied 
freely to the face, neck, hands, and arms. Dr. Carmichael states 
that a much smaller proportion of pine tar may be used without 
impairing the efficiency of the mixture. 

This solution makes a dirty mixture that will soil the clothing if 
brought into contact with it, but it prevents mosquitoes from bit¬ 
ing and does not injure the skin. It is readily removed by hot water 
and soap. 

Fleas. 

Fleas are small insects which have no wings, but get from one 
place to another by leaping or by being carried by their host. The 
popular idea that fleas can leap long distances is erroneous. The 
distance jumped is never over six inches. Fleas are brought into 
dwellings by domestic animals. They lay their eggs in the fur of 
the animal, but the eggs fall off to the floor, as they are not fas¬ 
tened to the hairs, and become mixed with the dust on the floor. 


58 


PREVENTION OF DISEASE AND CARE OF SICK. 


The eggs hatch in about five days, and the larvae probably feed 
upon the organic matter present in the floor dust. They moult their 
skin several times and finally spin cocoons in which they change to a 
pupa state. In a few days the cocoons split open and the adult in¬ 
sects emerge. 

Fleas are principally of interest on account of their ability to 
convey plague. This disease may be transmitted by the cat flea 
(Ctenocephalus fells'), the human flea (Pulex irritam ) , the squirrel 
flea (C eratophyllus ocutus ), the rat flea {C eratophyllus fasciatus ), 
and probably other species. The rat flea is, however, the chief one 
concerned in conveying the disease to man. It has been contended that 
the rat flea would not readily bite man, but experiments have 
proven that it will, under certain conditions, especially if its natural, 
food supply is scarce, and that it may convey the germs of plague, 
obtained by biting a rat suffering from the disease as long as three 
weeks. 

A house may be rid of fleas, or at least their number may be greatly 
diminished, by sprinkling flaked naphthalene on the floors and leav¬ 
ing the rooms closed for a number of hours. Water will destroy the 
larvae, but has little effect upon the adult fleas. Kerosene will loll 
them, and also sulphur fumes obtained by burning sulphur in pans 
(see p. 65) may be used for this purpose. Chloroform is useful 
in killing fleas on the body, as it may be poured through the clothing 
directly on the spot where the flea is located. 

Lice. 

Lice are small, round, flat insects which fasten themselves to the 
hair of warm-blooded animals, and, in the case of man, not only to 
the hair of his body but also to the clothing he wears. The eggs, 
called nits, can be seen in the hair as small white specks. They are 
difficult to remove on account of the sticky substance with which 
they are attached. 

Three kinds of lice infest human beings, the Pecliculus capitis or 
head louse, the Pediculus vestimenti or body louse, and the Phthirius 
pubis or crab louse. They cause itching and burning, and in some 
cases severe inflammation of the skin with the formation of sores. 
Crusts, interspersed with bleeding areas, may be present. The body 
louse, and possibly the head louse, transmits typhus fever, and per¬ 
haps other diseases from one person to another. 

Every effort should be made to free the body from lice and their 
eggs if one should be so unfortunate as to become infested with these 
insects. The head louse is destroyed by washing the hair with a 
mixture of equal parts of kerosene and vinegar, care being taken 
that it does not run down over the face or neck. The vinegar dis- 



Fig. 52. A raft of Culex ova. (After Fig. 56.—Larva of Anopheles mosquito. 

Deaderiek.) (Castellani and Chalmers. Modified 

after Howard.) 



Fig. 53.—Patterns assumed 
by Anopheles ova. (After 
Deaderiek.) 



Fig. 54.—Egg. Anopheles maeulipennis 
(quadrimaciilatus). (After Ludlow.) 



Fig. 57.—Larva of Anopheles macuii- 
pennis (quadrimaculatus). (Castel¬ 
lani and Chalmers, after Nuttalland 
Shipley.) 




2 


Fig. 55.—Larva of a Culex mosquito. 
(After Howard, y 


5 

Fig. 5S.—Pupae: 1, Culex: 2, Anoph¬ 
eles; 3, Aedes caiopus. (After 
Howard.) 




























Fig. 62.—Showing clearing and ditching done. 



Fig. 63.—Ditching of low area of pool formed by seepage water. Malaria prevailed among tenants 

in all houses. 













PREVENTION OF DISEASE AND CARE OF SICK. 


59 


solves the sticky substance which binds the nits to the hair, and the 
kerosene kills the lice. Gasoline is as efficient as kerosene, but it 
should not be used, as its inflammability is much greater than kero¬ 
sene. The danger of burning a patient in case either of these 
preparations is employed should be borne in mind, and the patient 
should be outdoors at the time of application and remain outside 
until the hair becomes dry. Several applications at intervals of two 
or three days are required, as the nits, or eggs, are hard to kill. 
These may sometimes be combed from the hair with a fine-toothed 
comb. The body louse lives in the clothing, so this should be boiled 
or baked. If this is impossible the clothing, and especially the 
seams, should be ironed with a hot iron. An efficient method is to 
soak the clothing in gasoline, or the vapor of gasoline may be forced 
through them. Another less expensive method is to put the clothes 
for half an hour in a soapy solution to which 2 per cent of trichlo- 
rethylene has been added. A good application to the body is a solu¬ 
tion made by mixing 1 part of gasoline with 3 parts of vaseline. 
This preparation is noninflammable under working conditions. An 
ointment made by mixing 5 parts of naphthalene with 95 parts vase¬ 
line is also useful for this purpose. Pubic lice, commonly known 
as “ crabs,” are destroyed by the application of white precipitate, 
or mercurial ointment. 

Lenz found that he could eradicate lice from prisoners at Puch- 
heim (near Munchen) by means of finely powdered naphthalene. A 
handful of this material is put into the patient’s clothing, introduced 
through the opening at the neck. He is made to sleep at night with 
all his clothes on. The body heat causes the naphthalene to evapo¬ 
rate, the vapor killing not only the lice but also most of the eggs. 
This treatment should be repeated every 4 days for a period of 12 
days. 

In the British Army a powder composed of naphthalene (96 
parts), creosote (2 parts), and iodoform (2 parts) is used. About 
two-thirds of 1 ounce is required for each man. Two tablespoonsful 
of an ointment made of crude mineral oil (9 parts), soft soap (5 
parts), and water (1 part) is rubbed into the interior seams of the 
clothing. Articles of underclothing are treated by dipping and 
wringing them out in a solution of 1 per cent each of naphthalene 
and sulphur in benzene or gasoline. 

Itch Mite (Sarcoptes Scabiei). 

The itch mite is a small parasite which burrows into the skin and 
produces a disease known as the itch or scabies. The irritation pro¬ 
duced by the mite causes scratching, which results in excoriations, 
papules, and pustules at places where the mite has entered. 


60 PREVENTION OF DISEASE AND CARE OF SICK. 

Prevention ,—A person with the itch should be careful not to shake 
hands with other persons. He should use separate towels and sleep 
in a bed by himself. He should, as far as possible, keep away from 
other people, particularly children, as they are especially susceptible 
to the disease. 

Treatment .—The patient should take a hot bath, using plenty of 
soap, and an ointment composed of powdered sulphur (2 teaspoons- 
ful) and vaseline (8 tablespoonsful) should then be well rubbed into 
the skin. The treatment is continued for three nights, and on the 
morning of the fourth, day the patient takes a bath and puts on 
clean clothing. If there is burning of the skin, a little zinc ointment 
may be rubbed in. The underwear and bed clothing should be boiled 
and the outer clothing ironed or baked. The treatment should be re¬ 
peated after an interval of three or four days if itching is still pres¬ 
ent. Another method of treatment is to rub the body with powdered 
sulphur every night for a week after taking a bath and also sprinkle 
it between the bed sheets at night and on the underwear during the 
da} 7 . The sheets and underwear should be changed each day. 

Ticks. 

Ticks are believed to feed upon blood alone. They attach them¬ 
selves to the skin of man and animals and partly burrow into it. 
They hold on tenaciously. If carelessly pulled off, the head may be 
torn from the body and remain in the skin. The eggs of ticks are 
deposited upon the ground. The larvae are six-legged creatures 
which catch hold of any animal within their reach. After becoming 
engorged with blood the larva drops off and changes to the third 
or nymph stage. The nymph, after obtaining more blood and shed¬ 
ding its skin, changes to the adult insect. The tick is instrumental 
in spreading Kocky Mountain spotted fever throughout some parts 
of the country. It should be removed from the skin by means of 
hartshorn, kerosene, turpentine, or carbolized vaseline, which pre¬ 
vent the head remaining in the skin. Persons traveling through 
woods or other places in a tick-infested country should stop and 
search their bodies every two or three hours and remove any ticks 
that may have attached themselves thereto. 

Bedbugs. 

The presence of bedbugs in dwellings is indicative of want of care 
and cleanliness as to bed, bedclothes, etc., and means should be taken 
to exterminate them when they appear. A liberal application of 
kerosene oil to the places infested is probably the best means of 
killing them. There are preparations of gasoline or naphtha sold 
which leave no stain when sprayed on painted or papered walls. 



Fig. 60.—Vegetation along the side of 
drainage ditches may be easily 
burned if saturated with crude oil. 



Fig. 61.—A garbage can having a hole in the bottom through 
which is passed a wick automatically feeds oil into 
ditches where mosquitoes might breed. 



Fig. 65.—Flea. 





Fig. 66.—Body louse (Pediculu 
corporis ). Magnified 20 times. 



Fig. 67.—Itch mite (Sarcopies scabiei). Male. 
Ventral view. The sucker on the fourth 
leg on the right is accidentally folded over 
the third leg. (From Bourguignon.) 


























Fig. 68.—Bedbug (Cimex lectularius): a, Larval skin shed at first molt; b, second 
larval stage taken immediately after emerging from a; c, same after first 
meal, distended with blood. Greatly enlarged. 



Fig. 69.—Fumigating gas for destruction of rats being pumped into 
hold of vessel. Plague eradicative campaign, New Orleans, 1914. 



Fig. 70.—An insanitary barn. 














PREVENTION OF DISEAvSE AND CARE OF SICK. 


61 


Badly infested rooms may be freed from bedbugs by fumigating 
with sulphur, using 2 pounds of sulphur to every thousand feet. 
The method of disinfecting with sulphur is described on page 65. 

Roaches. 

Roaches are believed to be responsible for the conveyance of tuber¬ 
culosis, diphtheria, typhoid fever, tonsillitis, and possibly some other 
diseases. They spread these diseases by carrying the organisms on 
their feet and in their intestinal canals and disseminating them over 
food supplies, books, and other articles in daily use. They are espe¬ 
cially abundant in the galleys of vessels and in damp kitchens. They 
appear at night after the lights have been turned off and overrun 
everything in the room. Roaches can be quickly, cheaply, and com¬ 
pletely exterminated from ships and houses by the use of sodium 
fluorid. This should be spread with a rubber powder blower on the 
floors near the walls and on shelves in closets. The powder does not 
suffocate the insects, but sticks to their feet. They clean it off with 
their mouths, some of it being swallowed and causing the death of 
the insect. As sodium fluorid is poisonous to man in doses of a 
tablespoonful or more care should be taken not to spread it over 
articles that are to be eaten. 

SANITATION OF VESSELS. 

Construction .—Section 2 of an act of Congress entitled “An act to 
promote the welfare of American seamen in the merchant marine of 
the United States,” etc., approved March 4, 1915, reads as follows: 

Sec. 2. That on all merchant vessels of the United States the construction of 
which shall he begun after the passage of this act, except yachts, pilot boats, or 
vessels of less than one hundred tons register, every place appropriated to the 
crew of the vessel shall have a space of not less than one hundred and twenty 
cubic feet and not less than sixteen square feet, measured on the floor or deck 
of that place, for each seaman or apprentice lodged therein, and each seaman 
shall have a separate berth and not more than one berth shall be placed one 
above another; such place or lodging shall be securely constructed, properly 
lighted, drained, heated, and ventilated, properly protected from weather and 
sea, and, as far as practicable, properly shut off and protected from the efliu- 
,vium of cargo or bilge water. And every such crew space shall be kept free 
from goods or stores not being the personal property of the crew occupying 
said place in use during the voyage. 

That in addition to the space allotment for lodgings hereinbefore provided, on 
all merchant vessels of the United States which in the ordinary course of their 
trade make voyages of more than three days’ duration between ports, and which 
carry a crew of twelve or more seamen, there shall be constructed a compart¬ 
ment, suitably separated from other spaces, for hospital purposes, and such com¬ 
partment shall have at least one bunk for every twelve seamen constituting 
her crew, provided that not more than six bunks shall be required in any case. 


62 


PREVENTION OF DISEASE AND CARE OF SICK. 


Every steamboat of the United States plying upon tlie Mississippi River or its 
tributaries shall furnish an appropriate place for the crew, which shall conform 
to the requirements of this section, so far as they are applicable thereto, by 
providing sleeping room in the engine room of such steamboat, properly pro¬ 
tected from the cold, wind, and rain by means of suitable awnings or screens on 
either side of the guards or sides and forward, reaching from the boiler deck to 
the lower or main deck, under the direction and approval of the Supervising 
Inspector General of Steam Vessels, and shall be properly heated. 

All merchant vessels of the United States, the construction of which shall be 
begun after the passage of this act, having more than ten men on deck must have 
at least one light, clean, and properly ventilated washing place. There shall be 
provided at least one washing outfit for every two men of the watch. The 
washing place shall be properly heated. A separate washing place shall be pro¬ 
vided for the fireroom and engine-room men, if their number exceed ten, which 
shall be large enough to accommodate at least one-sixth of them at the same 
time, and have hot and cold water supply and a sufficient number of wash 
basins, sinks, and shower baths. 

The sides of an iron ship are cold and anyone sitting or sleeping 
near them becomes chilled. In order to prevent this, spaces used 
for quarters should have the outside walls sheathed with plating, an 
air-tight space being left between the side plates of the ship and this 
plating. If the space is not air-tight the circulation of air within 
will cause sweating. The inside of this space should be lined with 
cork or asbestos or painted with cork paint. 

T entilation .—The ventilation of sailing ships is simple. All they 
require are a few air ducts leading from the deck to the forecastle 
cabin and galley. These ducts end in cowls, which can be turned to 
the wind to admit air into the compartments or away from the wind 
to draw it out. On steam vessels provision has to be made for remov¬ 
ing the large amount of air heated by radiation from the surface 
of boilers and steam and hot-water pipes. This heat is called “ wild 
heat, ? ' as it serves no useful purpose. There must be a number of 
large size ventilating pipes and fans or other apparatus employed 
throughout the ship to draw cold air in and force hot air out. The 
drawing in of the air is the more important, as a large part of the hot 
air is used in the combustion of fuel and escapes through the smoke¬ 
stack. The fireroom is said to be more comfortable in assisted draft. 
In this condition the natural intakes are closed and the air is drawn 
through the ventilators into the fireroom by fans. The hot air leaves 
by the same openings as in natural draft. Gatewood says: 

In order to diminish the temperature in firerooms and thus improve the con¬ 
ditions under which the men work, the use of assisted draft is becoming much 
more common, and by reducing number of fires it seems not improbable that 
the expenditure of coal may thus be made as economical under assisted draft 
as under natural draft at ordinary cruising speed. 

On passenger and war vessels there must be a system of ventilating 
pipes extending to all parts of the vessel, connected to fans operated 
by electric motors; the fresh air should be driven into the living 


PREVENTION OF DISEASE AND CARE OF SICK. 


63 


quarters and the stagnant air drawn out of places such as the galley, 
bathrooms, and water-closets. If some such system of ventilation 
were not provided, conditions aboard these vessels would be unbear¬ 
able. 

The temperature in the fireroom often rises as high as 130° F. 
The temperature and humidity of the fireroom should, if possible, 
be regulated so as to prevent the wet-bulb thermometer from rising 
above 81° F. Firemen, while on duty should be allowed plenty of 
ice water. If no ice water is obtainable, oatmeal water should be 
provided. A water butt should be placed where the men can easily 
get to it. When coming out of the fireroom into the cold outer air 
the men should protect themselves with adequate clothing and not 
rush out in undershirt and overalls. Owing to their carelessness in 
this respect, men of this class are subject to frequent colds, rheuma-* 
tism, and kidney disease. They should spend at least 2 hours of the 
24 on deck. The hours spent in the hot furnace room makes them 
“ tender ” to even a moderately cold atmosphere and it is difficult to 
induce them to spend a sufficient time in the open air. This applies 
also to cooks, stewards, and all persons whose work is inside the ship. 

Water .—The safest water to use on board a vessel is that provided 
by distillation. When it is not possible to have distilled water, great 
care should be exercised to procure water that has not been con¬ 
taminated bv sewage. An act of Congress approved June 4, 1914, 
states that— 

No person, firm, or corporation shall furnish water for drinking or cooking 
purposes to any vessel in any harbor of the United States intending to clear 
for some port within some other State or Territory of the United States, or 
the District of Columbia, taken from the waters of such harbor or from any 
other place where it has been or may have been contaminated by sewer dis¬ 
charges : Provided. That water in regard to the safety of which a reasonable 
doubt exists may be used if the same has been treated in such a manner as to 
render it incapable of conveying disease, and the fact of such treatment is 
certified by the interstate sanitary officer, or'the State or other health authority 
within whose jurisdiction it is obained. 

In foreign ports water of known purity should be obtained if 
possible; if not, the water taken aboard should be treated by adding 
a teaspoonful of chloride of lime, taken from a freshly opened tin, to 
each 512 gallons. Whenever practicable, the ship should be brought 
alongside of the wharf to receive water, as water obtained from water 
boats is notoriously bad. for even when the water is supplied from a 
source of unquestioned purity the men on these boats are careless in 
handling it and pollution results. In many cases if the owners of 
these boats are not watched they will pump water directly out of a 
contaminated stream into the tanks of the vessels they are supplying. 

Everyone on board a vessel should be provided with a separate 
towel, soap, and drinking cup for his individual use in order to 


64 


PREVENTION OF DISEASE AND CARE OF SICK. 


prevent conveyance of disease from one person to another. Water 
butts should have spigots and tight-fitting tops secured by lock and 
key to prevent seamen from dipping their cups into the water. 

Every vessel should carry at least sufficient water to provide 6 
gallons per day for each seaman and 10 gallons per day for each fire¬ 
man aboard. 

Ice used for cooling water should be clear, natural ice or ice made 
from distilled water or water certified as aforesaid, and before the 
ice is placed in the water it shall be first carefully washed with 
water of known safety and handled in such manner as to prevent its 
becoming contaminated by the organisms of infectious or contagious 
diseases. The foregoing does not, however, apply to ice which does 
not come in contact with the water which is to be cooled. 

Mosquitoes .—The ship should be kept free from mosquitoes. Mos¬ 
quitoes do not, as a rule, go far from land unless blown by the wind, 
so, if the vessel is to lie at anchor, a site should be chosen that is 
sufficiently far from the shore to escape them. When the ship is to 
lie at the dock or close to the shore, the living compartments should 
be protected by screens or wire netting of 18-mesh wire placed over 
the portholes, skylights, and ventilators. Closely fitting screened 
doors, with springs to shut them after being opened, should be pro¬ 
vided. Mosquito bars may be used over bunks, but these are nothing 
like as efficacious as screening. Mosquitoes should be looked for 
early in the morning and all that are found in the compartments 
should be killed. They are usually to be found on the screens trying 
to get out. 

Mosquitoes should not be permitted to breed on board. All bar¬ 
rels, water butts, and buckets, and all articles containing water 
should be kept covered or be screened. A bucket of fresh water 
without a cover that has been left in an out-of-the-way place and 
forgotten will provide a breeding place for hundreds of mosquitoes 
which may remain with the ship during a long voyage if she stays in 
tropical waters. The water in the bilges of the vessel and in the 
bottom of lifeboats should be treated with a small quantity of kero¬ 
sene oil, sufficient to provide a scum over its surface. Wiggle tails 
come to the surface of the water to breathe and the kerosene forms a 
film through which they can not pass to get air, and without air they 
can not live. The oiling should be done at least once a week as long 
as there are any mosquitoes on board. 

Rats come on board ship by way of the mooring lines or gang 
planks or conceal themselves in parcels or freight. They multiply 
rapidly, two females having been known to give birth to 180 in a 
year. They are omnivorous and can maintain themselves for long 
periods on very little food. They cause great damage to property 



Fig. 71.—Vessel properly fended from wharf with rat guards effectively fastened to lines. (Courtesy of Philadelphia Press.) 














Fig. 72.—Dirty flanks, a common condition in winter. Flanks 
become caked with manure, which there is often no thought 
of removing. This is the source of most of the dirt found 
in milk in the winter time. 



Fig. 73.—A clean, light, airy interior. Milkers at work 
are dressed in clean white suits and caps. Cows are 
clean. An ideal place. 



Fig. 75.—When puss becomes a menace to the family, 
















PREVENTION OF DISEASE AND CARE OF SICK. 


65 


and freight, and they are a medium by which plague is distributed 
around the world. The flea transmits the plague bacillus from one 
rat to another and from the rat to man. It does this by its bite. 
Vessels should be kept as free from rats as possible. Surgeon Cofer 

recommends that the following antirat measures be observed by ship 
captains: 

(o) Destruction of rats on vessels. 

( b ) Prevention of rats boarding vessels. 

To effect the destruction of rats on vessels the latter should be fumigated 
three or four times a year by sulphur burned in pots. 

Almost any kind or size of iron pot will answer the purpose. The ordinary 
sugar pan 2£ feet in diameter is useful in disinfecting the hold of a vessel or a 
large compartment, the number of pans to be determined by the number of 
thousand cubic feet of area to be fumigated. Not more than 30 pounds of sul¬ 
phur should be placed in each pot. For the fumigation of staterooms and the 
like the small iron cooking vessels are suitable. Each pot should always be 
placed in a tub of water, as shown in figure 12. 

The tubs should be made of wood or compressed paper, as tubs made of gal- » 
vanized iron or composition metal go to pieces rapidly through rust or breaks in 
the seams. The pots should nevqr be placed on the floor of a compartment or 
bottom of a hold of a vessel. In compartments or storerooms they should be 
placed upon tables or chairs, and in the holds of vessels either on the “ tween ” 
decks, upon piles of ballast, or upon boxes. The sulphur should always be 
ground or mashed into a powder before being placed in the pots, and should be 
piled around the sides of the pot with a central depression or crater. Alcohol 
should always be used for lighting sulphur, although a hot coal will answer the 
purpose. 

One pound of sulphur burned in a space containing 1,000 cubic feet will pro¬ 
duce 1 per cent of the gas. Five pounds of sulphur burned in a space containing 
1,000 cubic feet will produce 5 per cent of the gas. 

On empty vessels burn 2 pounds of sulphur for every 1,000 cubic feet of space 
and let the gas stand for six hours. 

In computing the capacity of the hold of a vessel for the purpose of deter¬ 
mining the number of thousand cubic feet of space therein, and therefore the 
number of pounds of sulphur which will be required to produce a 2 per cent 
volume of the gas, the net tonnage of the vessel shows in a general way the 
cubic capacity of her cargo-carrying space. Ten net tons will represent 1,000 
cubic feet of space; therefore for every 10 net tons 2 pounds of sulphur must 
be used to get the average 2 per cent volume strength of sulphur gas. The 
capacity of the living apartments, storerooms, and the like had best be figured 
on separately. 

In fumigating with sulphur gas all spaces must be made air-tight. In fumi¬ 
gating the holds of vessels the hatches should be covered with their regular 
waterproof tarpaulins and tightly battened down, leaving a small vent for the 
escape of the sulphur. All air slits, scuttles, and chain ports should be closed. 
The doors should be sealed by means of strips of paper pasted over the cracks 
left between the frame and the door. 

If the vessel has cargo the killing of rats should be carried out under the 
direction of the nearest quarantine officer. After the fumigation is over the 
rats should be gathered (with the hands protected by heavy gloves) and burned 
in the ship’s furnace or donkey-boiler fire-box, not in the galley. 

49071 ° — 23-6 



A RAT GUARD FDR SHIPS LINES 


66 


PREVENTION OF DISEASE AND CARE OF SICK. 


Now, the important thing is to keep the vessel from becoming reinfested with 
rats. This is effected by (1) the use of rat funnels or guards on all lines while 

the vessel is in port, (2) by 
keeping a watch for rats at¬ 
tempting to walk up the 
gangplank, (3) by keeping 
a sharp lookout for rats 
being concealed in loosely 
crated freight, (4) by keep¬ 
ing the ships’ food and stores 
carefully protected from rats, 
(5) by distributing rat poison 
(phosphorus or arsenic paste) 
in the vessel, (6) by keeping 
ship’s cats (they should not 
be overfed, else they will not 
try to catch rats), and, 
finally, by keeping rat traps 
constantly set. The follow¬ 
ing illustration shows what 
a rat guard looks like: 

The special points of this 
rat guard are these: A single 
shield in two parts, with 
arms (funnels) from both 
sides. It is hinged by bolt¬ 
ing at the outside of the 
shield. There is a guide 
permitting a perfect fit of 
the two parts of the disk 
when closed. It can be used 
on many different sizes of 
rope, and when placed on the 
line fits closely by tying on 
both sides. Rivets are used 
throughout, thus increasing 
the strength. The outside 
half of the arms is cut 
lengthwise into three strips 
so that they may be bent to 
come into immediate contact 
with the rope when tied. 

The details for making the 
rat guard are as follows: 
Flat sheet galvanized iron is 
used for all parts of the 
guard; 20 to 24 gauge an¬ 
swers best, for that weight 
of iron is strong enough and 
does not make the guard too 
heavy. The shield should 
not be less than 3 feet in diameter. The funnel tubes should be 18 inches 
long on each side of the shield. The central opening can be made to fit any 














PREVENTION OF DISEASE AND CARE OF SICK. 


67 


size of rope. One made for a 3-incli diameter rope will serve for all smaller 
sizes. When made or used for encircling a number of lines at the same time, 
the shield should be 4 feet in diameter and the funnel tube enlarged and sup¬ 
ported by five flanges and five rivets instead of three. The guide piece, which 
is the one important feature of this rat guard, is riveted on one side only and 
then bent around the circumference. The rivets which fasten the funnel tubes 
go through the tube flanges on each side of the shield. One bolt, two washers, 
and five rivets are needed for each guard. When badly damaged by use or 
carelessness, a block of wood and a hammer are all that is required to restore 
the guard to its former usefulness. 

When a ship is in port, especially in a plague-infected port, all gangways 
should be hoisted at night. The captain of a vessel should insist upon the 
repeated distribution of rat poison in the warehouses from which his cargo 
is to be taken. He should in some manner be able to inspect the freight 
intended for his vessel to guard against rats being taken aboard with loosely 
crated freight. By loosely crated freight is meant such articles as crockery or 
china packed in straw or excelsior or furniture or matting wrapped in gunny 
and loosely crated, also peanuts, rice, sugar, wheat, corn, oats, etc., shipped 
in bags. 

Wherever ships go—plague will go. No rats—no plague. 



CAMP SANITATION. 

By W. F. Draper, 

Passed Assistant Surf/eon, United States Public Health Service. 

The term “ camp ” is ordinarily understood to apply to a simple 
place of abode, somewhat removed from other settlements, and more 
or less temporary in character. The number of persons which a 
camp may contain is limited only by its facilities for affording the 
ordinary requirements of existence. 

By its very nature a camp is an independent unit, and every factor 
relating to the health and comfort of its occupants must receive 
careful consideration. Unlike the dweller in a city or municipality, 
the camp dweller will find no system of waste disposal already at 
hand, nor will there be regulations prescribing the manner in which 
he shall conduct his affairs for the protection of his own health and 
that of his neighbors. It is essential, therefore, that persons con¬ 
cerned with the establishment of camps and those who live in them 
should have a definite knowledge of the principles of sanitation. 

The Selection of a Camp Site. 

The ground selected must afford good, natural drainage, such, for 
example, as the top of a low ridge, the summit of a knoll with gently 
sloping sides, or the high bank of a river. In the case of a large 
camp, care must be taken that the drainage will not pollute the 
grounds or water supplies of dwellings or settlements which may be 
in the vicinity. Low places and swamps should be avoided. The 
dampness renders them very uncomfortable and in warm weather 
they usually abound in mosquitoes. 

Gravel and sand are excellent soils upon which to establish a 
camp, as the rain water sinks into the ground and the surface dries 
rapidly. Mixtures of sand, clay, and loam, while not so good as 
plain sand or gravel, are usually satisfactory. Clay is perhaps the 
least desirable constituent of soil for camp purposes. It absorbs 
and holds a great deal of moisture, which is only slowly given up 
by evaporation, and is especially disagreeable after a rain. 

Trees are highly desirable about a camp, as they afford protection 
from the sun and wind and are cooling in summer. The foliage 
should not be so dense as completely to exclude the rays of the sun, 
for under these conditions the ground may remain moist and the 
6S 


PREVENTION OF DISEASE AND CARE OF SICK. 


69 


camp structures may become damp and unliealthful. All under¬ 
brush should be thoroughly cleared away from the camp site because 
in the presence of moisture it affords breeding places for mosquitoes 
and also gives them protection in their flights. Grass on the camp 
grounds, when kept closely cut, prevents the washing and gutting 
of the soil by rains, does not reflect the glare and heat of the sun, 
and aids in the prevention of mud and dust. 

Camp Structures. 

Although many different types of camp structures are in use, 
the tent is perhaps the most common form of shelter. Tents are 
usually arranged in rows and the space between the tents should be 
about one and one-half times the width of each tent in order that 
light and air may have free access. 

Ditches should be dug around each tent in order that the floors 
may be kept dry in wet weather. The sides of the tents should be 
fastened up during the day when the weather permits so that the 
sun and air may reach every part of the interior. 

The question of the exact number of persons which may properly 
be assigned to a given space is difficult to answer. As the result of 
many observations of camps and with a knowledge of the economic 
problems with which they are confronted the conclusion has been 
reached that an allowance of 20 square feet of floor space and a dis¬ 
tance of 2 feet between each single bed or bunk are the least that can 
be provided without serious overcrowding. The separation of the 
beds and economy of floor space may be obtained by the use of 
double-deck bunks. 

Ventilation must be insured by leaving the door flaps,, or the sides, 
or both, open. Tents receive a considerable amount of air through 
the pores of the canvas; but when the temperature of the inside and 
outside air is about the same, and in wet weather, when the pores 
become closed by the contracting canvas, the ventilation may be bad, 
and openings in the ridge should always be provided. 

In places where mosquitoes are numerous the screening of the 
tents may be necessary. Mosquito bars over the beds, or head nets 
and gloves may be used. 

Beds and bedding should be inspected at regular intervals to insure 
cleanliness and freedom from vermin. All bedding should be placed 
out of doors in the sun and air all day at least once a week. 

Mess Tent and Cook Tent. 

Scrupulous cleanliness should be observed in the cook tent and 
mess tent and by those engaged in the preparation of the food. 
Whenever possible, these structures should be screened against flies, 


70 


PREVENTION OF DISEASE AND CARE OF SICK. 


and in cases where this can not be done the food should be protected 
from fly contamination by means of screened cupboards or covers 
made from wire mesh. Personal cleanliness is of the greatest im¬ 
portance in the case of those who come in contact with the food, and 
adequate facilities for washing the hands should be provided. Cooks 
and waiters should be furnished with white caps and aprons which 
may be laundered when soiled. The ordinary clothing may come 
in contact with all sorts of camp wastes and should not be worn 
during the preparation of the food unless covered with a clean 
apron. 

Water Supply. 

Water supplies for camps are generally derived from springs, 
streams, lakes, or wells. 

Although occurring pure in nature, springs may be readily pol¬ 
luted and made unfit for use. The contents of privies, stables, and 
hog pens may be washed over the surface of the ground by rains and 
so pollute the spring. Laundry wastes, bath wastes, or filthy ma¬ 
terial of any kind, if deposited on the surface of the ground near a 
spring, may carry disease germs into the water. It is of the utmost 
importance, therefore, that the surroundings of a spring should be 
kept scrupulously clean, and that no wastes of any sort should be 
thrown upon the ground. 

It frequently happens that spring water is neither sufficient in 
quantity nor convenient enough in location to furnish a supply for 
purposes other than drinking and cooking. In such cases additional 
water is often obtained from other sources, such as rivers or streams, 
thus creating a double water supply. 

When a camp is supplied with a safe water for drinking and cook¬ 
ing purposes, and an unsafe or unknown water for general camp use, 
certain dangers arise. Many persons are absolutely thoughtless in 
regard to the water which they drink, and an inferior water, if a 
little more convenient, will be readily used. Then, too, kitchen help 
are frequently found to have no very clear understanding as to what 
extent a doubtful water may be used for cooking purposes and dish¬ 
washing. Harmful organisms are killed by boiling, but not all the 
water used in the preparation of food is sure to reach the boiling 
point, and much of the water used in washing dishes never boils. 
The use of a doubtful water, therefore, in the preparation of food 
or for dishwashing is extremely dangerous, and even its presence in 
or about the kitchen and eating quarters is very unsafe. 

Disinfection of Water Supplies. 

Bleaching powder, also known as chloride of lime, chlorinated 
lime, and hypochlorite, is an efficient and inexpensive disinfectant 


PREVENTION OF DISEASE AND CARE OF SICK. 


71 


and should be applied to all doubtful water at a camp regardless of 
the purposes for which such water is used. In the quantities for 
which it is generally employed for the purification of water for 
drinking purposes it is harmless in its effect upon the human body, 
and its taste is almost imperceptible. 

Bleaching powder rapidly loses its strength when exposed to the 
air, and great care must be used to keep it tightly covered in air¬ 
tight containers. 

Directions for the use of bleaching powder in the purification of 
w ater for drinking purposes are given on page 34. 

Sewage Disposal. 

Human excreta must be disposed of in such a way that it will be 
prevented from dangerously polluting the soil, contaminating water 
supplies, or furnishing a breeding or feeding place for flies. 

The covered can shown on page 38 is a simple means of keeping 
conditions sanitary. One quart of compound cresol solution (see 
p. 104) added to 7 quarts of sewage will keep down the odor and 
destroy disease germs. 

When the foregoing instructions are carried out the toilet facili¬ 
ties may be located at any convenient place about the camp, but it 
is preferable to have them at least 50 feet distant from the eating 
and sleeping quarters. 

Final Disposal of Contents of Can. 

As most camps in which such a system of sewage disposal is desir¬ 
able are located in sparsely populated districts with plenty of vacant 
land surrounding them, disposal of the excreta by burial may, as a 
rule, be accomplished satisfactorily. The place selected for the 
burial should be at least 100 yards away from the water supply, and 
should not drain toward it. 

As the natural agencies of purification are present in the greatest 
numbers in the upper layers of the soil it is better that excreta should 
be given shallow burial rather than be thrown into deep pits. The 
deeper the pit in which it is placed the greater is the danger of pol¬ 
luting underground water supplies. 

Instead of the large pits which are frequently found at camps, 
shallow furrows or trenches should be dug. They should be from 6 
to 12 inches deep and the excreta should be scattered along in a layer 
about 2 inches thick and immediately covered with 6 to 12 inches of 
earth. 

Garbage Disposal. 

Covered metal cans should be provided for garbage. The wooden 
pails, buckets, and barrels so frequently used at camps are unsuitable 


72 


PREVENTION OF DISEASE AND CARE OF SICK. 


containers. They are seldom provided with covers and are difficult 
to clean. They swell and warp, allowing the liquid portions of the 
garbage to leak through and saturate the surrounding ground and 
rapidly go to pieces, often falling apart in the process of dumping. 

A metal garbage can of suitable size and with a tight fitting 
cover can be purchased at almost any hardware store for a sum not 
exceeding one dollar. Such a receptacle is water-tight and very 
serviceable: when kept covered it remains free from flies and does 
not give off disagreeable odors. 

Garbage cans should be washed out and scalded with boiling hot 
water at frequent intervals to prevent them from becoming unneces¬ 
sarily foul. Moisture is the immediate cause of the souring of gar¬ 
bage, therefore the drier it is the longer it can be kept without being 
a nuisance. If garbage is drained and then wrapped in paper before 
being placed in the can it will not smell in hot weather nor freeze 
and stick to the can in cold weather. The can will not become dirtv 
and will not require emptying more than once or twice a week. 

Destruction of both liquid and solid garbage wastes by fire is far 
preferable to any other means of disposal and gives absolute security. 

A very simple type of incinerator may be constructed by digging 
a trench 5 feet long, 2-| feet wide, 6 inches deep at one end and 12 inches 
deep at the other. The trench is then filled with field stones, upon 
which the fire is built, and the excavated earth is banked about the 
sides. After the stones have become thoroughly heated, liquid wastes 
are poured into the trench at the shallow end. They come into con¬ 
tact with the hot stones at the bottom and are evaporated without 
destroying the fire. The solid wastes are placed on the fire where 
they soon dry out and burn as fuel. 

If stones are not available tin cans may be substituted and used 
repeatedly. When neither stones nor cans are at hand a fire made in 
a trench of this character will destroy a considerable amount of gar¬ 
bage, both liquid and solid, but it is better to use stones or cans when¬ 
ever possible. 

Suppression of Flies. 

In many camps flies are present in such numbers as to be a veri¬ 
table scourge, and the screening of kitchens and mess rooms is fre¬ 
quently unsuccessful because of the overwhelming odds against it. 

The favorite breeding places of common flies is in horse manure. 
Flies also breed in human filth, a fact which makes them especially 
dangerous to health of human beings. Even in camps where no 
horses are kept and where the excreta is properly disposed of flies 
may sometimes be found in large numbers. In such cases there may 
be neighboring stables and barns which furnish their quota of flies, 
or they may be found breeding in decaying vegetable or animal 


PREVENTION OF DISEASE AND CARE OF SICK. 


73 


material, in exposed garbage, in hogpens, poultry yards, or any other 
places which permit of the accumulation of filth. 

Fly suppression in camps can be successfully accomplished only by 
doing away with their breeding places. Screens, fly traps, sticky fly 
paper, and poisons are all useful in waging war against flies, but are 
not in themselves sufficient. The fundamental rule to be enforced 
is that of absolute cleanliness of the camp and its surroundings. 
Human excreta, horse manure, garbage, and other wastes must be 
kept protected from flies. 

As flies seldom travel more than 500 yards from their breeding 
places, the location of stables, hogpens, and chicken yards in their 
relation to the camp is of great importance, and they should be placed 
as far away as practicable. Hogpens, especially, must be placed a 
long distance off—one-quarter of a mile being advisable. 


PERSONAL HYGIENE. 


Diet. 

In order that a diet shall be nourishing it must be properly bal¬ 
anced and contain a sufficient quantity of the constituents that have 
been found to be essential to life. These constituents consist of (1) 
nitrogenous substances: (2) starches and sugars; (3) oils and fats; 
(4) salts; (5) vitamines; (6) water. 1 

Constituents (1), (2). and (3) are depended upon, among other 
things, for heat production and the daily quantity required may, 
therefore, be expressed in calories, or heat units. A man doing hard 
work needs from 3,500 to 5,000 calories a day. A pound of meat, a 
loaf of bread, and a quarter pound of fat contain about 3.500 calories. 
Some men can get along on less while others consume more, but this 
is the average amount eaten. Many persons overeat. In such the 
tongue becomes coated, there is a bitter taste in the mouth, bowels 
are constipated, there is lassitude, drowsiness, and often severe head¬ 
ache. When overeating is persisted in for a long time it may pro¬ 
duce obesity, gout, and degeneration of the walls of the blood vessels, 
leading to apoplexy, paralysis, heart and kidney disease. This is 
especially true if large quantities of meat are consumed. The food 
should be varied from clay to clav. If this is not clone the diet 

•j 

becomes monotonous and distasteful. 

The nitrogenous elements in such foods as meat, eggs, milk, cereals, 
etc., are primarily tissue or flesh formers. Oils and fats, both 
vegetable and animal, together with starchy food, such as bread, 
potatoes, rice, beets, etc., are primarily force or heat producers. 
Meat should be cooked with heat sufficient to kill any animal para¬ 
sites that it may contain. Cooking also softens the tissues which 
hold the muscle fibers together; it makes meat more tender, appe¬ 
tizing, digestible, and improves its flavor. Fruits and green vege¬ 
tables are needed to furnish vegetable acids, mineral salts, and 
vitamines. Vitamines are present in varying amounts in almost all 
natural foods but are particularly abundant in milk, eggs, green 
vegetables, and fruits. Vegetables and fruits in the raw state should 
be thoroughly washed before being eaten to remove any injurious 
germs which may be present. This should be done with the utmost 
care before eating radishes, lettuce, watercress, and celery, as dysen¬ 
tery, typhoid fever, and intestinal parasites have often been con¬ 
veyed by them. 


1 See Appendix R, Note 12, p. .‘*>14. 
74 




PREVENTION OF DISEASE AND CARE OF SICK. 


75 


Pellagra is believed to be due to a diet which lacks certain 
nitrogenous compounds. The nitrogenous elements of the diet are 
likely to be defective when they are too largely derived from cereals 
and too little from animal foods and fresh, green vegetables. A 
biscuit, corn bread, “ fat meat,’’ and molasses diet unless supple¬ 
mented with plenty of milk, green vegetables, and lean flesh foods 
(fresh meat, eggs, fish) is likely to lead to the development of 
pellagra. 

The vitamines. of which some four or five are now known, are 
essential elements in a properly nourishing diet. If a one-sided, 
monotonous diet is eaten, an insufficient amount of some of these 
elements mav be consumed and serious results are likely to follow. 
A diet composed too largely of the ordinary white rice may lead to 
beriberi, but a man living on rice with the outer coating left on will 
not develop the disease. Moreover, if a man is sick with beriberi 
and he is given rice bran he will recover, if the disease has not 
progressed too far. There is a substance, a vitamine, in the outer 
layer of the rice kernel which prevents beriberi. 

Milk. 

Milk is a complete food in itself, as it contains nitrogenous ele¬ 
ments in the form of albumen and casein, fat as cream, milk sugar, 
salts, and water. As it is usually consumed in the raw state and as 
it is an animal 
product, great care 
should be exer¬ 
cised to see that 
it is clean and 
free from disease 
germs. There are 
three classes of 
milk on the mar¬ 
ket: Certified milk, 
inspected milk, 
and market milk. 

Special precau¬ 
tions are taken to 
prevent the con¬ 
tamination of cer¬ 
tified milk, which 

should not contain 

over 10 000 bac- FlG - ^4. —Milk bottles being filled and capped by machinery. 

1 The best method. 

teria to the cubic 

centimeter. The dairies are subject to frequent inspection; the cows 
must be tested for tuberculosis and be examined by veterinarians 
at frequent intervals. The stables must be well ventilated and of 
















































































































































76 


PREVENTION OF DISEASE AND CARE OF SICK. 


sanitary construction. The animals must be kept clean and be 
well cared for. The bag and udder should be washed before 
each milking. No manure should be allowed to remain around 
the building. The attendants must wear white clothing and 
must take frequent baths, and their hands and nails must be 
kept scrupulously clean. They must not be suffering from any 
communicable diseases or harbor the germs of such diseases. 
The milk must be carefully drawn from the cow so that no* 

dirt will get into it. It should 


i a#zr 

1 


'mm 



be immediately cooled thereafter, 
placed in sterile bottles, and kept 
at a temperature not above 50° F. 
until used. Inspected milk is 
milk obtained under the same 
precautions, except that the re¬ 
quirements for cleanliness are 
Fig. 76.—Two kinds of milk pails. The not quite so rigid. The number 

open pail admits the dirt; the covered 0 f bacteria per 1 Cubic ceilti- 
pail keeps much of it out. 

meter may be as high as 100,000. 
Market milk includes all other milk. It should be pasteurized before 
using. It is also safer to pasteurize inspected milk. The process of 
pasteurization is described on page 190. 

If a family has a cow, everything about the stable should be kept 
as clean as possible. The walls should be whitewashed and no manure 
should be allowed to remain in the building, but should be placed out¬ 
side in a covered barrel or manure box (see fig. 39) and removed 
from the premises at least once a week. The cow should be brushed 



1 . 2 . 3 . 4 . 

Fig. 77.—Four grades of milk as indicated by the dirt test. One 
pint of milk was poured through each of these disks of absorb¬ 
ent cotton, which were perfectly white at first. They show 
four grades of milk, as follows : 1, Perfectly clean ; 2, slightly 
dirty ; 3, dirty ; 4, very dirty. 

outside the building to remove all dust and dirt. A farmer will spend 
considerable time brushing his horse, but will never think of brushing 
his cow. The udder and teats should be thoroughly washed and dried 
with a clean cloth before milking. The milk pail should not be used 
as a container for the water needed for washing the cow. The milker 
should carefully wash his hands before beginning operations. No 
one with sores on his hands, or who is suffering from a communi¬ 
cable disease, or is caring for a person suffering from such a disease 
should milk a cow, as the germs of disease may be conveyed to the 
milk and infect other persons. Milk from animals with sores on their 







PREVENTION OF DISEASE AND CARE OF SICK. 77 

teats should not be used, as severe sore throat may be caused thereby. 
The milk should be strained through a cloth and kept in a cool place 
free from dust. The milk pail should be scalded out with boiling 
water and drained without wiping. 

Alcoholic Liquor. 

Alcohol is a narcotic poison. Its action upon the human body is 
injurious and often leads to fatal results. The sale of liquors con¬ 
taining it is as carefully restricted as that of morphine, cocaine, and 
other poisons. “Bootleg" and other illicit liquors may have mad¬ 
dening effects, making the subject temporarily a dangerous maniac, 
or they may cause death. Alcohol is especially dangerous, as it 
seldom immediately kills, and to the casual observer appears to pro¬ 
duce no permanent harm, but it should be remembered that persons 
who are addicted to the use of alcohol are more liable to contract 
diseases, as this poison lowers the vitality of the body and diminishes 
its power of resistance when attacked by the germs of disease. 

The symptoms produced by alcohol are similar to those caused by 
the inhalation of ether or chloroform. There is a first stage of excite¬ 
ment, in which the person experiences a feeling of well-being; he is 
talkative and imagines that he is making a good impression upon 
those who are present. He loses his self-control, and his judgment 
and sense of propriety, duty, and responsibility are impaired. There 
is a lack of muscular coordination, as shown by the staggering gait, 
thick speech, and trembling hands. In the second stage there is de¬ 
lirium, general weakness, and depression, followed in the third stage 
by paralysis, profound sleep, insensibility, coma, and sometimes 
death. Any of these symptoms may be present, depending upon the 
amount of alcohol taken and the susceptibilty of the person to the 
action of the poison. The continued use of alcohol may produce 
chronic inflammation of the stomach, liver, kidneys, heart, and other 
organs of the body. The drooping lip, bleary eyes, reddened nose, 
dilated veins, and muscular tremor of the chronic drunkard are well 
known. The effect on the nervous system is startling, for besides 
causing disease of the lower centers, conducting fibers and nerves, 
the higher centers are severely injured, as is shown by the number of 
persons committed to asylums suffering from alcoholic insanity. It 
is estimated that one-fifth of the persons admitted to these institu¬ 
tions have been made insane by alcohol. In other cases, persons of 
weak mentality, who might otherwise live fairly useful lives, are 
pushed over the brink and rendered insane by alcohol, the tempta¬ 
tion to indulge in which such persons are unable to resist, resulting 
in their becoming charges upon the State through their inability to 
support themselves. 


78 


PREVENTION OF DISEASE AND CARE OF SICK. 


Those who advise the use of liquors containing alcohol claim, first, 
that it is a stimulant. This is an erroneous idea, as although alcohol 
does at first slightly increase the blood pressure, there is soon a 
lowering of the same with symptoms of depression. Second, that 
it prevents one from catching cold. As a matter of fact, alcohol di¬ 
lates the blood vessels under the skin, which results in a large amount 
of blood being brought to the surface, with a subsequent loss of heat 
and chilling of the body. Many cases of pneumonia are due to this 
cause. Arctic explorers and those exposed to severe cold find that 
the ingestion of alcohol is harmful and prefer hot tea or coffee. 
Third, that alcohol is a food. It is true that in persons accustomed 
to its use about an ounce of alcohol, which is the amount contained 
in a bottle of beer, may be used up in the body in a day. Any excess 
of this amount is excreted by the lungs or the kidneys. It is ques¬ 
tionable whether the amount that is not excreted is itself a source of 
heat and energy, as the effects apparently due to it may be due to 
its action upon starches and foods. In any event its food value is 
small and not to be compared to other substances which are much 
better suited to the purpose. Fourth, that it is a medicine. It is 
seldom necessary to use alcohol for its medicinal effect. In such 
conditions as tuberculosis, heart disease, and shock, where it was 
formerly extensively employed, it is now considered to be harmful. 
It is true it has a certain value in the prostration of acute fevers, 
where food can not be administered, but even here other measures 
are preferable. In Guy’s Hospital. London, the cost of alcohol 
administered to patients has been reduced from $7,660 to $734 per 
annum. In the United States Public Health Service during the 
fiscal year 1917 only 89^ gallons of alcoholic liquor were issued to 
the 20 marine hospitals, in which 11.325 patients were treated. 

The use of light wines and beer, the former of which contains from 
5 to 10 per cent and the latter from 2 to 8 per cent of alcohol, is less 
harmful than the distilled liquors, such as brandy, whisky, gin. rum. 
etc. The majority of the people of Germany drink beer and of Italy 
wine. It must be remembered, however, that the death rate of even 
moderate drinkers is much higher than that of abstainers. Some 
insurance companies estimate it to be nearly 20 per cent more. In 
order to increase the efficiency of the population during the recent 
great war in Europe the English Government has had to greatly 
curtail the sale of alcoholic liquors, and in Russia their sale has been 
entirely prohibited. The following appeal was made by the Academv 
of Medicine in Paris to soldiers, warning them with regard to alco¬ 
holic beverages: 


i 


PREVENTION OF DISEASE AND CARE OF SICK. 


79 


SOLDIERS, BEWARE OF ALCOHOL. 

Those who, like you, are exposed to exhausting labor, to perilous enterprises, 
and to strong emotions, are ever inclined to look to alcohol as a stimulant and a 
comforter, and to seek for it in the tavern as a distraction from the monotony 
of cantonment and garrison life. 

It is therefore well that you should know what use you may make of alcohol 
without impairing your health. 

Certain errors about alcohol are widespread. 

1. It is said to give strength. This is not exact. The truth is it gives a false 
spurt of short duration, but a grave diminution of strength never fails to follow 
this excitement. Thus alcohol takes away more strength than it gives. 

2. It is also said that alcohol gives warmth. This is true for a few minutes, 
but the feeling of warmth which spreads over the limbs after a nip of brandy 
is delusive and is soon followed by a lessening of warmth and strength. Men 
who take nips are far more subject to chills and to diseases to which men at the 
front are liable. 

3. It is further asserted that in the form of a “ pick-me-up ” alcohol stimu¬ 
lates the appetite. This is quite wrong. It would be difficult to produce any 
man whose appetite had ever been really stimulated by a “ pick-me-up.” These 
aperitifs, habitually taken, lead without fail to disease of the stomach, liver, 
and mind. 

4. Lastly, it is maintained that alcohol taken during meals as wine, beer, or 
cider aids digestion. An important distinction must be drawn between “ dis¬ 
tilled ” liquors like brandy and “ fermented ” liquors such as wine, cider, and 
beer. Alcohol is altogether noxious. The petit verre after meals should only 
be taken on rare occasions. Fermented liquors, on the other hand, may be 
drunk subject to two conditions: they must be consumed in great moderation, 
which, as regards wine, should never exceed 1 liter (If pints) in 24 hours and 
only at meals. 

Exercise. 

In order to feel well it is necessary to take a certain amount of 
exercise, preferably in the open air. This is especially important 
if the person is a student, clerk, or engaged in some other sedentary 
occupation. The physical condition of the body is as important as 
the intellectual, for if the former breaks down the mental activities 
are greatly interfered with or rendered altogether impossible. Exer¬ 
cise should never be carried to the extent of fatigue or breathless¬ 
ness. When these conditions arise a rest should be taken until they 
have entirely passed away. If exercise is persisted in under these 
circumstances serious injury may be done to the heart. In young 
persons the usual outdoor games and sports, such as tennis, baseball, 
swimming, and boating, are the best. Women and girls should take 
part in these recreations as well as men and boys. Setting-up exer¬ 
cises are especially beneficial for young persons, inasmuch as an 
all-round development is more nearly possible with this method 
than any other. These consist in alternately lowering and raising 
the body, moving it forward and backward and from side to side, and 
in swinging the arms and moving the legs in all possible directions. 


80 


PREVENTION OF DISEASE AND CARE OF SICK. 


A full description of them is given in books upon physical training. 
They are best taken as a drill by a number of people at the same 
time. Persons over 50 years old should not exercise violently. Their 
outdoor recreation should consist chiefly of riding, walking, and play¬ 
ing golf, where a sudden strenuous effort is not required. 

Fatigue. 

This condition is a sign that the »ody forces are strained and that 
if work is continued injury may result. This injury may not be ap¬ 
parent immediately, but will show itself in a weakened heart or 
nervous prostration later on. It results from two causes: The using 
up of organic force or energy, and the wear and tear of the organs 
which are overworked, so that matter and energy are consumed, 
while restitution does not keep pace with the work. It has been 
found that accidents are more liable to happen if employees are over¬ 
worked, and that A person can not do efficient work if he is fatigued. 

Hours of labor depend upon the character of the work, but where 
it is possible to do so the days should be divided into eight hours of 
work, eight hours of sleep, and eight hours of recreation, with one 
full day’s rest once a week. In some cases, where the work is more 
than usuallv laborious or the nervous strain greater than ordinarv, 
more hours of rest will be required. During the hours of recreation 
the mind should be free from the problems with which it is occupied 
during the hours of labor, so that the person may start in again 
fresh and invigorated. 

Clothing. 

Clothing worn in the house in winter should not be thick and 
heavy, as the body is then kept too warm, perspiration forms, and 
chilling occurs when going outdoors. It is much better to wear 
thinner clothing and put on thick wraps when going outside. In 
summer the clothing should be of a light color, as white absorbs the 
least heat. Woolen material is best in winter, as it is a poor con¬ 
ductor of heat. It also absorbs moisture and checks the evaporation 
of perspiration. Several thin, loosely-woven garments are warmer 
than a thick one. The advantage results from the layers of warm air 
inclosed between the meshes of the material. Undergarments, when 
made of wool, frequently irritate the skin, so merino, which is a 
mixture of wool and cotton, is generally used in its place for this pur¬ 
pose. Underclothes should be frequently washed, as it is necessary 
that they should be kept clean as possible. Woolen garments are 
liable to shrink unless the washing is carefully done. Such garments 
should be plunged one at a time in tepid soapsuds; they should be 
gently squeezed, but should not be subjected to hard rubbing. The 
soap should be rinsed out carefully with tepid water, after which 


PREVENTION OF DISEASE AND CARE OF SICK. 81 

they should be hung up to dry without wringing. If there is a tend¬ 
ency to shrink they should be stretched into shape while drying. 

Baths. 

A bath should be taken at least once a day by everybody. The tem¬ 
perature of the water is of minor importance, except that a warm 
bath is more cleansing than a cold one. Old people, children, and 
weak persons should not take cold baths, as they are too depressing 
for such persons; nor should they be taken by anyone except in the 
morning and unless they are followed by a feeling of exhilaration. 
In order to bring about this condition after a bath the body should 
be rubbed briskly with a dry towel. A warm bath at night fre¬ 
quently induces sleep and is often beneficial to persons of a nervous 
temperament. In order to avoid catching cold, care should be taken 
not to sit in a draft after a warm bath. Shower baths are better 
than tub baths, as the water runs off the body and is not used again. 

Care of the Mouth and Teeth. 

It is important to take good care of the teeth. If they are allowed 
to decay, the food can not be masticated, indigestion results, and the 
body is not properly nourished. The bony processes of the jaws 
which hold the teeth in place are absorbed after the teeth fall out, 
allowing the cheeks to sink in, which makes the face look long and 
thin. 

Dental decay is caused by fermentation of small particles of food 
which are permitted to remain in the crevices between the teeth. 

This fermentation is due to bacteria and results in the formation 

«., _ - • 

of acids which dissolve the lime salts of the teeth. The hard white 
outside coating of the teeth, known as the enamel, is first attacked. 
This is destroyed at spots where the food is lodged and the softer 
interior substance of the tooth is exposed; this is rapidly eaten away, 
and a cavity is formed which increases in size until only a hollow 
shell of enamel remains. The nerves of the teeth are extremely sen¬ 
sitive, and severe pain or toothache is produced when dental decay 
extends into a tooth. An abscess or gumboil may form at the root 
of a tooth. This causes a throbbing pain, swelling, and fever. It 
usually breaks through the gum, discharging pus, with relief of the 
symptoms; sometimes, however, the inflammation extends to the 
bone, ending in its necrosis or death. Occasionally pus organisms 
are absorbed into the blood and blood poisoning ensues. 

An unclean mouth makes an ideal home for small organisms 
known as endameba buccalis, which many believe are the cause of 
pyorrhea dentalis or Rigg’s disease. In this disease there is inflam¬ 
mation of the gums, which become soft, swollen, and bleed easily. 
The disease extends around the roots of the teeth, pus exudes from 
49671 °—23-74-8 



82 


PREVENTION OF DISEASE AND CARE OF SICK. 


their sockets, they are loosened, and ultimately fall out. The process 
may take a number of years, but more than half of the permanent 
teeth are lost in this way. 

An unclean condition of the mouth renders the person more liable 
to catch cold, to attacks of influenza, bronchitis, and pneumonia. 
Headaches and neuralgic pains are often due to bad teeth. Many 
cases of so-called rheumatism result from the absorption of poison 
from the mouth and disappear when the disease conditions in the 
mouth are remedied. The same poisons often lead to sore throat, 
inflammation of the tonsils, disease of the eye and ear, and disor¬ 
dered digestion. 

The teeth should be cleaned with a toothbrush at least twice a day, 
and care should be taken that all particles of food are removed. 
Wooden and metal toothpicks should not be used, as the gums are 
liable to be injured, which may be followed by inflammation and 
absorption of septic products. Quill toothpicks are less objection¬ 
able, but should be employed with care. When brushing the teeth, 
a small quantity of tooth powder should be placed upon the brush. 
The formula of one of the best tooth powders is as follows: 


Magnesium peroxide_60 parts 

Sodium perborate_30 parts 

Powdered Castile soap and flavoring_10 parts 


When a tooth powder is not available Castile soap can be used for 
cleansing the teeth. 

Every person should visit a dentist at least twice a j T ear to have 
his teeth examined, cleaned, and necessary repair work performed. 
A dentist should also be consulted whenever there is toothache or a 
gumboil. If it is impossible to obtain the services of one. temporary 
relief from toothache can be obtained by cleaning out the cavity and 
putting in two or three drops of oil of cloves on a small piece of cot¬ 
ton. For toothache without the presence of a decayed tooth to cause 
it, the application of heat to the seat of the pain will often give relief. 

A gumboil should be opened by inserting a sharp-pointed knife 
along the side of the tooth down to the abscess cavity and cutting 
forward and outward. Before doing this operation the mouth should 
be rinsed out with a solution containing one part of hydrogen 
peroxide and three parts of water or some other antiseptic wash. 
The knife should be boiled before it is used, and the hands of the 
operator should be carefully cleansed with soap and water before 
performing the operation. 

The treatment for Rigg’s disease requires, that the tartar and yel¬ 
lowish matter which has accumulated along the edges of the teeth 
and between the teeth be removed by a dentist, who should be con¬ 
sulted as to further treatment. 





PREVENTION OF DISEASE AND CARE OF SICK. 


83 


Care of the Feet . 1 

1. A good marching shoe should be large enough in all directions, 
but not too large. If the foot moves in the shoe it is liable to chafe 
and blister. A common defect in shoes is that they are too tight 
over the instep and too loose across the ball of the foot. If the 
leather forward of the instep is too slack, wrinkles will form. Folds 
of leather and rough inner seams should be avoided. The inner 
edge of the shoe should be almost straight, the sole thick and wide, 
projecting beyond the upper leather. The heel should be low and 
broad, and the toe of the shoe should be of such a length that there 
will be no pressure on the ends of the toes or toenails. 

2. The toenails should be cut straight across, a little behind the end 
of the toe, and should not be rounded. Any tendency to ingrowing 
should receive treatment at once. 

3. Corns and callosities are due to pressure and friction from un¬ 
hygienic shoes. When between the toes they are soft; on other 
parts they are dry and hard. They often render men unfit for 
duty. 

Treatment .— (a) Remove the cause by wearing hygienic shoes. 
Soak the feet well in hot water, thoroughly disinfecting them with 
bichloride (1 part bichloride of mercury to 2,000 parts water) or 
other disinfectant and then pare the corn or callus down with a sharp 
knife without wounding the skin. The hands of the person and the 
knife should be sterilized before the operation is performed. (See 
p. 184.) Fragments of glass and sandpaper should not be used on 
corns. Persons should be cautioned about the care and treatment of 
corns as a slight w T ound of the foot may lead to lockjaw or blood poi¬ 
soning. Soft corns should be treated by applying a dusting powder 
like aristol on cotton or gauze between the toes. 

(b) Apply the following collodian paint with a camel’s-hair brush, 
night and morning, for several days, then soak the feet in hot water, 
and the corn will come away painlessly: 


Acid salicylic--1 dram. 

Extract cannabis indicse_10 grains. 

Oollodii__1 ounce. 

M. C. Corn paint. 


4. Blisters .—Save the skin: drain at the lowest point with a clean 
needle. Protect with adhesive plaster. 

5. Excessive and foul perspiration .—Excessive perspiration often 
leads to foot soreness, blisters, fissures, and corns, and may be of¬ 
fensive. 


1 From “The Landing Force and Small Arms Instructions” U. S. Navy. 








84 


PREVENTION OF DISEASE AND CARE OF SICK. 


(a) Mild cases will be relieved by dusting into the shoe and onto 
the foot the following “ foot powder” : 

Acid salicylic_ 3 parts. 

Pulverized amyli_10 parts. 

Talci_87 parts. 

This foot powder may be used with benefit before a march, especi¬ 
ally in cases of sore or tender feet. 

(b) Severe cases will be relieved by soaking the feet, after a pre¬ 
liminary scrub with soap and water, in a solution of permanganate 
of potassium. The stain should be left on the feet. The solution 
should be gradually increased from 1 per cent to 6 per cent and the 
treatment continued nightly for three weeks. The foot powder 
should be used during the day. 

(c?) Another method of treatment is to sprinkle a few drops of 
formalin into the shoe each morning. 

6. The feet should be well greased with tallow or neat’s-foot oil 
before a march, or the inside of the stockings should be covered with 
a stiff lather of common yellow soap well rubbed in, or the foot 
powder may be freely used. 

7. Should the stockings cause pain, the pressure is sometimes 
relieved by shifting them to the other foot or by turning them inside 
out. Within two hours after reaching camp the feet should be 
wiped off with a wet cloth, clean stockings put on, and those which 
are removed washed for the following day, if possible. 

8. Men unaccustomed to marching may toughen their feet by 
soaking them in strong, tepid, alum water (a teaspoonful to a pint!. 

CHILDBIRTH (LABOR). 

Women usually go to a hospital or remain at home when they 
expect to give birth to a child, but occasionally labor begins without 
warning while the woman is traveling or otherwise unprepared. 
This is due in most cases to the period of gestation having been 
shorter than normal or miscalculation having been made by the 
woman or her physician as to the time labor should commence. 

Normal labor is divided into three stages. The first stage extends 
from the beginning of labor pains until the mouth of the womb is 
completely dilated by the head of the child; the second extends from 
this point to the birth of the child; and the third from the birth of 
the child to the extrusion of the afterbirth. The length of the first 
stage is ordinarily about 12 hours, the second 1 hour, and the third 
30 minutes. There is, however, great variation in this respect, and 
in some cases the child is born in a few minutes. 

Symptoms .—During the first stage the woman is restless and ap¬ 
prehensive. At first the pains are not severe and occur not oftener 
than every 10 or 15 m inutes. They are sharp, lancinating in character, 





PREVENTION OP DISEASE AND CARE OP SICK. 


85 


and feel very much like cramps in the abdomen due to indigestion. 
The pains gradually become more frequent, stronger, and longer in 
duration. They may last a full minute, during which time the woman 
will hold on to the bed, a chair, or anything that is within her reach. 
At the end of this period the sac inclosing the child bursts, and a 
portion of the water which it contains gushes forth. 

During the second stage the pains are more powerful. The woman 
holds her breath, braces her feet, and uses all her muscles in an effort 
to expel the child from the womb. It is pushed through the pelvis, 
the soft parts at the end of the birth canal become stretched, and the 
head of the child is forced by an extra severe pain through the 
genital opening. The rest of the child is delivered after one or two 
more pains. This is followed by a discharge of blood and water, the 
former being from blood vessels which are ruptured when the after¬ 
birth is separated from the walls of the womb, and the latter being 
the remainder of the water which surrounded the child in the womb. 
There is always some blood lost at every childbirth, so this hem¬ 
orrhage need not cause alarm unless the woman’s pulse becomes 
weak, her face pale, or she gasps for air. After the expulsion of the 
child the pains cease and the woman has an opportunity to rest. In 
half an hour or so the pains return and the afterbirth is expelled. 

Care and treatment .—The woman should be made as comfortable 
as possible, but should not be required to lie down until after the bag 
of waters (the sac surrounding the child in the womb) has burst. 
Before this occurs she should pass her urine and an injection of warm 
water and soap should be given into the rectum to clear out all fecal 
matter. The lower part of the body should be washed with soap and 
water and then with a solution of bichloride, 1 part to 5,000 (one 71- 
grain tablet of bichloride of mercury dissolved in 5 pints of water). 
Under no circumstances should water, oil, or any other liquid be 
injected into the birth canal, nor should anyone introduce a finger or 
other article into this canal to see “ how the labor is getting along ” or 
for any other reason. The bed should be covered with clean sheets. 
A piece of rubber sheeting or other waterproof article should be 
placed under the lower sheet to protect the mattress, and a number 
of other sheets or clean towels should be spread under the woman’s 
hips to catch the discharge. The attendant who is caring for the woman 
should have on a clean white dress, and her hands and nails should be 
scrubbed with soap and water and then soaked in the bichloride solu¬ 
tion (1 to 5,000). If she soils her hands in any way they should be 
again washed and disinfected in the bichloride solution. The woman 
in labor should not be held during a pain, but she should be allowed 
to hold on to any person or thing she grasps. When the genital 
outlet begins to bulge the nurse should place her disinfected hand 
on the tense tissues at the lower part of the outlet and gently but 


86 


PREVENTION OF DISEASE AND CARE OF SICK. 


firmly retard the downward movement of the head during a pain in 
order to prevent if possible the tearing of the tissue. As soon as the 
child is born it will usually cry, when it should be wrapped in a soft 
blanket and laid between the mother’s legs. The nurse should now 
place her hand oh the mother’s abdomen and feel for the womb. 
This should be easily recognized as a hard, round ball. The mother 
should be carefully watched, and if no symptoms of faintness ap¬ 
pear the nurse may turn her attention to the child for a few minutes. 
The natal cord should be tied with a strong thread in two places 
about an inch apart, the lower thread being placed about 1 inch 
from the child’s abdomen. The thread used for this purpose should 
have been previously boiled. If there has been no opportunity 
to boil the thread it may be disinfected by placing it in the bichloride 
solution for 10 minutes, but boiling is the safest procedure. The cord 
should be cut between the two places where it has been tied, and the 
baby, after being wrapped in a blanket, placed in its basket. 

If the baby does not cry immediately after being born the nurse 
should introduce her finger into its mouth and remove any mucus 
which may be present. It should then be gently slapped on the hips 
or sprinkled with cold water. If it still does not cry the cord should 
be quickly tied and artificial respiration performed. The nurse 
seizes the child by the shoulders, holds it with the feet down and its 
back toward herself. She stands with her legs apart and at first 
all ows the child to hang down between them, she then slowly carries 
the child over her head in such a manner that the legs fall toward its 
face so that the body becomes sharply flexed, after which she brings 
it back to its original position. This motion is repeated four or five 
times a minute. Efforts at resuscitation should be persevered in as 
long as the heart continues to beat. Successful results have been 
obtained after trials lasting for 20 to 30 minutes. 

While waiting for the afterbirth to come away, watch carefully 
for hemorrhage. Dark clots need cause no alarm. A gush of bright 
red blood or a fainting attack, which may be due to a hemorrhage 
retained in the womb, call for quick action. Place the hand upon 
the mother’s abdomen, make gentle but firm pressure, and grasp the 
uterus from above downward. It can be felt through the abdominal 
walls and can be made to contract firmly by gentle rubbing and pres¬ 
sure. This will usually stop the hemorrhage at once. For faintness, 
raise the foot of the bed 12 inches or more and keep the patient’s head 
low. Allow the womb to relax at intervals until the afterbirth is 
expelled, after which a teaspoonful of extract of ergot may be given. 

The hand should never be introduced into the birth canal, as 
there is great danger of introducing germs which may subsequently 
cause blood poisoning and death of the mother. Never pull upon 
the cord as this expands the afterbirth and makes it difficult to 
remove. As soon as the afterbirth is grasped it should be turned 


PREVENTION OF DISEASE AND CARE OF SICK. 


87 


round and round so that the membranes attached to it may be 
twisted in a cord and thus brought out of the womb. If the mother 
shows no signs of faintness no effort should be made to squeeze 
the afterbirth from the womb for at least half an hour, as pains 
frequently return within that time and the afterbirth is expelled 
without assistance from the nurse. In either case the nurse should 
not forget to twist the membranes into a cord, for if they are not 
removed in this wav infection of the womb may occur. The soiled 
sheets should now be removed from the bed and clean ones substi¬ 
tuted, care being taken not to raise the mother’s head, after which a 
binder should be placed on the mother’s abdomen, using a stout pil¬ 
lowcase for this purpose held tightly in place with safety pins. A 
pad of clean towels should be placed under the mother to catch the 
discharge and she should be allowed to go to sleep. The birth canal 
should not be washed out with water or any other liquid after the 
child is born or during the mothers convalescence. 

The baby should be rubbed with olive oil and given a warm bath. 
Its eyes should be washed with boric acid solution and a drop of a 1 
per cent solution of nitrate of silver placed in each eye in accordance 
with the directions given on page 178. The stump of the cord should 
be well powdered with boracic acid covered with a pad of sterile ab¬ 
sorbent cotton which should be held in place by small strips of ad¬ 
hesive plaster. 

THE CARE OF THE BABY. 1 

I. Some Important Truths. 

1. It is easier, better, and cheaper to prevent than to cure disease. 

2. Everything that protects the mother before her baby is born 
improves the health of the baby after its birth. 

3. Many of the diseases observed in older children and adults begin 
in infancy. 

4. Healthy babies make strong men and women. 

5. The baby’s food, home, and surroundings play an important 
part in keeping it well or making it sick. 

6. Mother’s milk is the best food for babies. 

7. Cow’s milk which has become infected with disease germs kills 
many babies. 

8. Extreme heat and impure air kills many babies in the summer, 
especially bottle-fed babies. 

9. The health and happiness of the whole househould are improved 
by everything done to protect the baby. 

i Prepared by a committee of the American Association for the Study and Prevention 
©f Infant Mortality, except paragraphs on “ Home Modification of Milk,” “ Constipation,” 
" Colic,” and “ Condensed Milk.” 




88 


PREVENTION OF DISEASE AND CARE OF SICK. 


II. General Suggestions for the Care and Feeding of Infants. 

mother’s milk—nature’s FOOD. 

1. The most loving act a mother can do is to nurse her baby. When 
the baby nurses, it not only gets the best food, but it is less liable to 
many diseases, such as “ summer complaint,” convulsions, and tuber¬ 
culosis. Out of every 100 bottle-fed babies an average of 30 die in 
the first year, while of the breast-fed babies only about 7 out of 
every 100 die in the first year. 

2. Nearly every mother can nurse her baby during the first 3 or 
4 months of its life, and if she can nurse it for 10 months, so much 
the better. 

3. There may be an abundant supply of milk after the first few 
weeks, even if there is but little at first; the act of suckling causes the 
milk to come into the breasts, and increases the supply. It is very 
important that the baby nurse regularly. 

4. If the baby is too weak to nurse, a healthy infant can be used 
to excite the flow of milk until the baby has grown strong enough to 
nurse. This should not be done without a physician’s advice. 

5. The only way to tell how much food the baby is getting is to 
w r eigh it before and after each nursing; for at least 24 hours. The 
clothes need not be removed, but the baby should be dressed in exactly 
the same way when weighed after nursing as before. (If the baby 
should soil its diaper after the first weighing do not change it until 
after the second weighing.) In case the baby is not getting enough 
breast milk, the quantity lacking should be made up by properly pre¬ 
pared cow’s milk. Let a physician decide this. This may be only a 
temporary shortage on the mother’s part, and with suitable care the 
milk will probably increase so that the baby will eventually be satis¬ 
fied with the breast only. 

6. The following things influence the milk supply: Peace of mind 
is necessary for the mother; she must not worry; she should not get 
overtired. She should eat freely of her customary diet. The total 
quantity of fluids taken by her in 24 hours should not be less than 2 
quarts; in hot weather more. Stuffing, however, is unnecessary and 
undesirable. 

7. Consumption in the mother is practically the only disease that 
always forbids nursing. Paleness, nervousness, fatigue, pains in the 
back and chest, or the return of the monthly sickness are not sufficient 
reasons for weaning, but when these symptoms are present or preg¬ 
nancy ensues a physician should be consulted at once. 

8. Shortly after birth, boiled water, without sugar, may be given 
to the baby at regular intervals until the mother’s milk supply is 
established. The baby, however, should be put to the breast at stated 
times, as often as the mother’s condition permits. 


PREVENTION OF DISEASE AND CARE OF SICK. 


89 


IMPORTANT POINTS TO P>E REMEMBERED IN NURSING THE BABY. 

It is always wise to make nursing as easy as possible for the mother 
and to give her opportunities for rest. Therefore, the sooner the baby 
is satisfied and gaining on three-hour or even four-hour intervals the 
better. 

Convenient hours for nursing the baby are as follows: 

(1) Seven nursings in 24 hours: 6 a. m., 9 a. m., 12 noon, 3 p. m., 
6 p. m., 9 or 10 p. m., and once during the night. 

(2) Six nursings in 24 hours: 6 a. m., 9 a. m., 12 noon, 3 p. m., 
6 p. m., and at the mother’s bedtime; or at 6 a. m., 10 a. m., 2 p. m.. 
6 p. m., 10 p. m., and once during the night. 

(3) Five nursings in 24 hours: 6 a. m., 10 a. m., 2 p. m., 6 p. m., 10 
p. m.. or later. 

The baby should be offered cooled boiled water between feedings, 
especially during hot weather. 

The length of time for nursing varies with the individual and the 
breast. The average infant rarely nurses longer than 15 minutes. 
The important point is to satisfy the baby. If there is any doubt, let 
it nurse longer, but not more than 20 minutes. If it is not satisfied 
after 20 minutes, consult a physician. 

It is customary to nurse only one breast at each feeding, and to 
use them alternately. If, however, the baby does not get enough from 
one breast, give it both. 

It is important to keep the nipples clean; they should be washed 
before each nursing. Caked breasts or cracked nipples are the usual 
causes of breast abscesses, and although they may be harmful to the 
mother, they do not make the milk poisonous for the baby. In both 
instances consult a physician. In order to avoid abscess, a caked 
breast should be gently rubbed with olive oil. Caked nipples should 
be washed before and after each nursing with boric-acid solution (one 
teaspoonful of boric acid to a glass of hot water). 

III. Weaning. 

The baby should be completely weaned at the end of the first year. 
I T p to this time breast milk should be given to the baby as long as it 
thrives. It is better, when possible, to continue nursing through 
the summer and to wean in the fall. It is better to wean in the sum¬ 
mer than in the spring, if by doing so the baby can have breast milk 
longer. 

Do not wean the baby suddenly; it should be done gradually by 
replacing one breast feeding at a time with a bottle feeding. Several 
weeks are required for weaning. 

It is dangerous to wean a young baby. It should not be done for 
the convenience of the mother and should never be done without the 
advice of a physician. 


90 


PREVENTION OF DISEASE AND CARE OF SICK. 


Contagious disease in the mother does not mean that it is neces¬ 
sary to wean the baby. In case of severe illness, contagious or other¬ 
wise, a temporary weaning may be necessary for the mother’s sake. 
A physician should decide this. As soon as the mother’s condition 
permits, the baby should be put back on the breast. The supply of 
breast milk can sometimes be brought back by putting the baby 
regularly to the breast for several days, even when nursing has been 
stopped for several weeks. 

IV. Mixed Feeding. 

When the mothers milk is diminishing it is advisable to make up 
the lack with properly prepared cow’s milk. This may be done either 
by following one or more breast feedings with enough modified milk 
to satisfy the baby or by giving one or more full-bottle feedings in 
place of a like number of breast feedings. 

The flow of breast milk tends to diminish when the baby nurses 
less than five times in 24 hours. When the baby is being nursed once 
every 4 hours and is not satisfied, it is better to give him after 
Cursing enough modified milk to satisfy him, rather than to replace 
a nursing with the bottle. If, on the other hand, shorter intervals 
and more feedings are being used, a bottle feeding may take the 
place of a nursing without so much danger of decreasing the milk 
supply. Most babies need additional food after the seventh month. 

V. Bottle Feeding. 

Cow’s milk is the most satisfactory substitute for mother’s milk. 

The best milk (this does not mean the richest milk) is none too 
good. Get “ certified ” milk if possible. If you can not obtain 
certified milk, get the cleanest and purest bottled milk you can find. 
Milk sold in bulk, or bottled from the can in stores, or by milkmen 
in their wagons, is likely to be stale and contaminated and not a 
proper food for the baby, even though it looks and tastes good. 
“ Baby foods ” and condensed milks and the like are not satisfactory 
substitutes for good cow’s milk and often harm the baby. 

Raw milk may carry the germs of tuberculosis, scarlet fever, 
tonsillitis, diphtheria, typhoid, and other communicable diseases 
Unless the milk is above suspicion, danger should be prevented by 
proper pasteurization of the milk or by boiling or by sterilization. 

Pasteurization .—Pasteurization means heating the milk to about 
150° F. for 30 minutes and then rapidly cooling it. Milk for the 
baby should always be pasteurized in the feeding bottle. It may be 
done as follows: The milk should be mixed and poured into the 
clean feeding bottles, which should then be stopped with clean non¬ 
absorbent cotton. It is then ready for pasteurization. While a 


PREVENTION OF DISEASE AND CARE OF SICK. 91 

number of satisfactory pasteurizers may be bought in the shops, a 
home-made pasteurizer can be easily constructed. 

Take a wire basket that will hold all the nursing bottles for 24 
hours and place this basket containing the bottles in a vessel of cold 
water tilled to a point a little above the level of the milk. Heat the 
water and allow it to boil for five minutes. Then run cold water into 
the vessel until the milk is cooled to the temperature of the running 
water. The milk is then put into the ice chest, which should be not 
warmer than 50° F. 

Sterilization .—By sterilization of milk is meant the process of ren¬ 
dering it germ free by boiling it on 3 successive days or by keeping 
it for 15 minutes under pressure at a temperature of 242° F. 

Boiling .—Milk is boiled for one or two minutes in a large vessel and 
poured immediately into the sterilized bottles, stoppered with cotton. 



Fig. 78.—Pastpurizer for infant feeding bottles that can he 
- made by any tinsmith. 


rapidly cooled in running water, and put on the ice. This destroys 
all living bacteria, but not spores or eggs, which will not do harm 
unless the milk is kept too long after boiling. It should be used 
within 24 hours. 

If the baby’s milk is to be mixed with other ingredients, such as 
oatmeal, barley water, rice water, sugar, etc., these should be added 
to the milk before pasteurization, boiling, or sterilization. When the 
milk is once prepared the bottle should not be opened until it is given 
to the baby. 

Home modificaticm of milk .—A mother should nurse her baby 
whenever it is possible, but in case of her death or severe illness it 
becomes necessary to provide other food for the baby. Some mothers 
are unable to supply enough breast milk and the nursing has to be 






























































92 


PREVENTION OF DISEASE AND CARE OF SICK. 


supplemented by other nourishment. Cow’s milk must be modified 
before it can be given to infants. The amount of fat is the same in 
woman’s and cow’s milk, but the latter contains more proteins and 
salts. Young babies can not digest the large amounts of proteins in 
cow’s milk, so it must be diluted with water and cream and sugar 
added in order to make the mixture conform more closely to the com¬ 
position of mother’s milk. Limewater or milk of magnesia has also 
to be added to make the mixture slightly alkaline, as cow’s milk is 
acid. Holt, in Sajous’s Cyclopedia of Practical Medicine, gives the 
following rules for the preparation of food for healthy infants: 

Whereas it is impossible to give simple rules by which every infant can be 
successfully fed, still experience shows that average healthy infants under 1 
year old may be fed according to a schedule arranged for certain periods. The 
schedule applies to healthy infants of average weight, under average conditions, 
and is meant to serve as a general guide, not to be blindly followed, for varying 
circumstances will modify any plan of feeding. 

Either whole milk or top milk may be used for making up the milk formulae. 
If top milk is used, it should never be stronger than the upper half of the 
bottle, the top 16 ounces being removed by use of the ounce dipper. For healthy 
infants with a good digestion the use of milk mixtures made from top milk is 
advantageous and the amount of fat in such mixtures will seldom cause any 
indigestion. For infants with feeble digestions, however, or for those that 
have recently recovered from diarrhea, top-milk mixtures are not advisable; 
instead the formulae should be made from whole milk or even from skimmed 
milk. In general, it may be said that during the first three or four months the 
top mixtures should he used. After the fourth or fifth month the food should 
be made up from whole milk. 

As a general guide, it may he stated that during the first week of life the 
naby will need from 3 to 5 ounces of milk or top milk. This may be diluted 
with 8 ounces of water and 1 ounce of limewater, and to it should be added 
1 to 2 even tablespoon fills of milk sugar. The baby should take from 1 to 2 
ounces of such a formula eight times in 24 hours. 

At one month the baby will need about 10 ounces of milk or top milk. This 
may he diluted with 16 ounces of water or barley water and 2 ounces of lime- 
water ; 3 even tablespoonfuls of milk sugar should be added, and the baby may 
be offered from 3 to 4 ounces seven times in 24 hours. 

At three months the baby will need about 16 ounces of milk or top milk, 
to which is added 14 ounces of cereal diluent, 2 ounces of limewater, and 4 
even tablespoonfuls of milk sugar. The baby may take between 4 and 5 ounces 
six or seven times in 24 hours. 

At 6 months the baby will need from 18 to 21 ounces of mixed milk, to 
which are added 18 ounces of a cereal diluent, 5 or 6 even tablespoonfuls of 
milk sugar, and 2 ounces of limewater. Tbe baby may take between 6 and 7 
ounces six times in the 24 hours. At 8 months the baby will take about the 
same quantity of food, but should have the intervals between the feedings 
changed to 4 hours, taking about 8 ounces at each feeding five times in the 24 
hours. If the child is large and well developed and has a good digestion, a 
small amount of thoroughly cooked cereal, such as cream of wheat or farina, 
may be given at two of the feedings; and at 9 months part or the whole of a 
soft-cooked egg may he given at the midday feeding in addition to the bottle. 
The baby should be encouraged to chew on a crust of bread or zwieback in 


PREVENTION OF DISEASE AND CARE OF SICK. 


93 


order to learn how to swallow solid food. At 9 months the formula may be 
three-fourths milk and one-fourth of thick cereal gruel, and as the cereal given 
by itself is increased the amount used in the formula may be diminished, so 
that by 10 or 12 months the baby should be taking whole milk. 

Cane sugar may be used instead of milk sugar, but only half the 
quantity should be employed. 

Constipation .—If the baby is constipated, the milk should be 
diluted with oatmeal water instead of plain water. It is also well 
to increase the proportions of the other ingredients of the mixture. A 
baby's bowels should move every day, and if they have not done so 
a soap stick should be used before the baby is put to bed. This stick 
is made by whittling a small piece of white soap so that its end can be 
gently introduced into the baby’s rectum, where it should be held 
for a few moments. This will usually result in the baby’s imme- 
diately having a movement. Special care should be taken not to 
injure the baby’s bowels. The soap stick should be coated with a 
little vaseline, and no force should be employed. A little sweetened 
orange juice will often overcome constipation. 

Diarrhea .—When the baby has diarrhea, either with or without 
vomiting, stop all food at once. Give it 1 or 2 teaspoonfuls of 
castor oil, allow it to have plenty of boiled water to drink, and 
send, if possible, for a physician immediately. Save the soiled 
diapers for the physician to examine. (Always keep them covered.) 

If the baby refuses to drink unsweetened, cooled, boiled water, 
give it barley or oatmeal water. 

Be sure to wash the hands thoroughly after changing a diaper 
and before preparing food. Boil all the soiled diapers for half an 
hour to kill the dangerous germs which might spread the diarrhea 
among the other members of the household. Keep the diapers in 
a solution of strong disinfectant (2 tablespoonfuls of pure carbolic 
acid in 2 quarts of warm water) in a covered vessel until ready to 
boil. 

Colic .—This is often due to too much fat or protein in the milk 
mixture, or giving the baby too large a quantity of food. It may 
be avoided by reducing the total quantity of food, or by using less 
milk and more water in the milk mixture. It may often be prevented 
by holding the baby over the shoulder after feeding and then to put 
it in a semireclining position on its side. Gas and swallowed air 
which is giving the baby discomfort is thus permitted to escape. 
Five or ten drops, according to age. of peppermint water in a little 
warm water may be of benefit. Paregoric in the same doses may be 
employed in severe cases, but the latter remedy should not be used 
frequently, as it causes constipation and masks other symptoms. An 
endeavor should be made to cure the condition by changing the com¬ 
position of the milk mixture to suit the baby’s digestion. 


94 PREVENTION OF DISEASE AND CARE OF SICK. 

Condensed milk .—This milk contains too much sugar and is de¬ 
ficient in protein and fat. Its continued use makes a large, flabby 
baby and anemia, scurvy, or rickets are liable to develop. It may 
be necessary to employ condensed milk as a temporary measure when 
traveling or during very hot weather, if fresh milk can not be ob¬ 
tained. It should be diluted with water to 1 in 8 or 1 in 12. Cream 
should be added and it is well to give a little orange juice each day. 

Oatmeal and barley water .—Add 2 teaspoonfuls of oatmeal or 
barley flour to a pint of boiling water. Boil for 20 minutes and then 
strain. 

Preservation of the baby's milk .—After the baby’s milk has been 
prepared it is very important that it should be kept cold until it is 
used. 

A simple ice box can be made as follows: Procure a wooden box 
about 18 inches square and 12 inches deep. Get two tin boxes, one 

about 11 inches square and 9 inches 
deep, the other 10 inches square and 9 
inches deep. Cracker boxes will do. 
Cut the bottom out of the larger box. 
Place 3 inches of sawdust in the wooden 
box. Put the larger bottomless box 
upon the layer of sawdust and fill the 
space between the wooden and the outer 
tin box with sawdust. Fasten the pieces 
forming the lid of the wooden box to¬ 
gether with cleats nailed on the outer 
surface. Tack about 50 layers of news¬ 
papers, cut to the size of the wooden box, 
to the inner surface of the lid. Make 
hinges for the lid by tacking two strips 
of leather onto the outside of the box and then tack additional strips 
of leather to the front edge of the lid to catch on nails driven into 
that side of the box, in order to hold the lid down tightly. The ice 
box is now ready for use. Into the smaller tin box put your wire 
basket containing the filled and stoppered nursing bottles (or a 
quart and a pint bottle of milk) and surround them with cracked ice. 
Place the smaller tin box inside the larger and close the lid. Each 
morning remove the inner box, pour out the water, clean, and repack 
with ice. Keep the ice box in a cool, shady place. (Fig. 79.) 

This ice box, if properly cared for, and kept full of ice, will keep a 
day’s supply of milk cool and sweet. 

PRECAUTIONS TO BE OBSERVED IN PREPARING THE BABy’s FOOD. 

$ 

Evervthing that comes in contact with the babv's food must be 
clean. The hands should be washed with hot water, soap, nailbrush, 









































PREVENTION OF DISEASE AND CARE OF SICK. 


95 


and dried with a clean towel before touching anything that goes 
into the baby's mouth. The dishes used in preparing the food should 
be boiled and allowed to dry 
from their own heat. Do not 
u$e a dish towel. 

Bottles .—As soon as the baby 
has finished his feeding, throw 
out any remaining milk, rinse 
the nursing bottle and fill it 
with cold water. When ready 
to prepare the milk for the 
next 24 hours, empty the bottles, 
wash them thoroughly with hot soapsuds and a bottle brush, and 
then rinse and boil them for 15 minutes. The bottles are then ready 
for filling. (Fig. 80.) 

Nipples .—Only nipples that can be kept clean easily should be 
used. They should be turned inside out, scrubbed, cleansed, and 
boiled. After boiling they should be kept covered in a clean, dry 



Fig. 80.—All utensils for the baby should 
be sterilized. 



glass. Dirty nipples should not be kept with clean ones. Never use 
nipples connected with long glass or rubber tubes. (Fig. 81.) 

DIRECTIONS FOR THE BOTTLE FEEDING OF BABIES. 

Complete instructions for bottle feeding can not be given in a 
booklet like this. Babies that are artificially fed should be under the 
supervision of a physician, w 7 ho should see them at regular intervals. 
Very young babies, or those that are not thriving, should always be 
seen once a week, while older healthy babies should Vie seen at least 
once a month, whether they are sick or well. The following rules 
and suggestions apply to all bottle-fed babies: 

Before feeding warm the food to blood heat by putting the bottle 
in a vessel of warm water. Do not test the temperature of the milk 













































































































9G 


PREVENTION OF DISEASE AND CARE OF SICK. 


by putting the nipple in your own mouth, but sprinkle a few drops 
on the inner surface of your arm. Be careful not to allow the food 
to become too hot and see that it does not cool too much while the 
baby is nursing. This can be prevented by wrapping the bottle in 
a piece of flannel. 

Hold the bottle for the baby throughout the feeding. Do not coax 
the baby to take more food than it wants, and do not allow it to 
drink longer than 20 minutes from the bottle. If it takes longer, 
there is something the matter with the baby or with the nipple. 

If there is any food left in the bottle, throw it away; do not give 
it to the baby later. 

Convenient feeding hours are the same as those for the breast-fed 
babies. (See p. 89.) 

VI. The Home. 

The welfare of the baby depends largely upon the condition of its 
home and surroundings. 

Fresh air .—A satisfactory home for a baby should provide plenty 
of fresh air and sunshine. Much of the baby’s time should be spent 
out of doors after it is 3 months old—on a porch or in the yard. A 
healthy baby should be kept out of doors at least four hours each 
day, even in winter, except when it is colder than 22° F. During 
the summer a newly born baby may be taken out of doors in the first 
week. During the winter months the baby should be gradually 
accustomed to the outside air. A good plan is to begin with an 
outing, of 15 minutes at noon and gradually lengthen the time into 
the forenoon and afternoon, until the baby is out from 10 a. m. until 
2 p. m. The baby must be properly clothed, according to the weather. 

The surroundings of the home should be free from uncovered 
garbage, rubbish, and manure. All of these attract flies and other 
disease-carrying insects. 

VII. The Baby’s Room. 

A quiet room, if possible with a south or southwesterly exposure, 
should be reserved for the baby. It should be well ventilated at all 
times. An open fireplace is desirable. The room should contain no 
upholstered furniture or heavy curtains. The walls and floors should 
be so finished as to allow frequent wiping with a damp cloth. A porch 
adjoining the baby’s room and running water near by are desirable. 
The temperature of the baby’s room should be kept not higher than 
68° or 70° in winter and in summer should be kept as cool as possible 
with awnings and shutters. The windows should be kept open day 
and night in summer and in winter the room should be aired two or 
three times a day. The windows and doors should be screened 


PREVENTION- OF DISEASE AND CARE OF SICK. 


07 


against flies and other disease-carrying insects. In the absence of 
screens, mosquito netting may be tacked on the outside of the win¬ 
dows. The cellar of the house should be dry. 

VIII. Clothing. 

Improper clothing may be harmful to babies in three ways: First, 
by being so tight that it prevents normal movements; second, by 
keeping the baby too warm; and, third, by not keeping it warm 
enough. The first fault can be avoided by making all of the baby 
clothes loose and roomv. Do not put on so manv clothes that the 
baby perspires. All clothing except the shirt band and diaper may 
be removed in very hot weather. As the weather grows cooler, other 
clothing is added. The important thing for the mother to remember 
is that the baby is very sensitive to both heat and cold. She must 
be constantly on her guard to keep the baby cool enough in summer 
and warm enough in winter. The principal object of clothing is to 
insure a uniform body temperature. Loosely woven material should 
be used to allow proper ventilation for the skin. The use of a flannel 
bellyband is necessary until the cord drops off. After the first month 
it may be replaced by a knitted band with shoulder straps. 


LIST OF CLOTHES FOR NEWLY BORN BABY. 


Three flannel binders (* yard of 27- 
inch flannel). 

Three shirts, wool and silk or wool 
and cotton. 

Two flannel petticoats. 

Two flannel or knitted sacques. 

Two pairs of worsted socks. 

Two dozen diapers, 22 by 44 inches. 
One dozen diapers, 25 by 50 inches. 
Four white muslin slips. 


One cloak. 

One warm cap. 

One pair of mittens. 

One veil. 

Two blankets. 

One box talcum powder. 

Two dozen safety pins, large and 
small. 

Two bath towels. 

Two soft towels. 


LATER. 

Three pairs of woolen stockings. Additional diapers. 

Three knitted bands with shoulder 
straps. 

IX. Sleep. 

Every baby needs 20 hours of sleep a day in its first month and not 
less than 16 up to the twelfth month of its first year. It should sleep 
alone, not in a cradle, but in a crib. If no crib is available, a clothes 
basket or a box of sufficient size is a good substitute. An expensive 
mattress is not necessary. A simple mattress made of excelsior and 
covered with a heavy blanket will answer very well. A sufficient 

%/ v 

quantity of clean bed clothing should be provided. 

The room should be darkened and well ventilated; the windows 
should always be open at the top at least 6 inches, except in the 

49671°—23-S 



98 


PREVENTION OF DISEASE AND CARE OF SICK. 


coldest weather. If the baby cries when it should be asleep, it is 
probably sick, overfed, or hungry. 

All children should take a nap of from one to two hours in the mid¬ 
dle of the day until they are 6 years old. 

X. The Bath. 

Every baby should be bathed at least once a day; during the hot 
weather two or three sponge baths may be given in 24 hours. The 
temperature of the bath should be from 90° to 95° F. in the early 
months. By the end of the first year the temperature may be low¬ 
ered to 80° to 85° F. If you have no thermometer, a practical test 
for the correct temperature is to use water that feels warm to the 
elbow. 

When bathing the baby in a tub let it rest upon your left arm, 
which is slipped under its back from the baby’s right side. By 
grasping the baby under the armpit with the left hand a good hold 
is secured which prevents slipping. The right hand is left free for 
washing the baby. A special wash cloth, preferably of cheesecloth, 
should be provided for washing the baby's face and head. 

After the baby is taken out of the tub it should be dried in a large 
soft bath towel. 

Do not wash a healthy baby's mouth; it will do no good and may 
do harm. As soon as the babv has teeth, clean them carefully with 

t/ 7 c/ 

a soft clean cloth or gauze, and later with a soft toothbrush and 
cooled, boiled water. 

After the baby is dressed it is wise to keep it indoors for at least 
an hour after bathing and to protect it from drafts. 

The best time for bathing the baby is just before its morning feed¬ 
ing, between 8 and 10 o’clock. After its bath the baby will be ready 
to take its food and go to sleep. 

XI. Weighing the Baby. 

The baby should be weighed regularly at least once a week for 
the first year and the record of the weight kept in a book. The most 
convenient time for weighing the baby is before the regular bath in ’ 
the morning. It is well to remember that the record of the baby’s 
gain in weight will be reliable only if it has been weighed at the same 
hour each time. 

XII. The Normal Baby. 

An average healthy baby weighs from 7 to 7-J pounds at birth, 
15 pounds at 5 or 6 months, and 21 pounds at 12 months. In other 
words, the baby doubles its weight in 6 months and trebles it in 12 
months. 


PREVENTION OF DISEASE AND CARE OF SICK. 99 

It is 20 to 21 inches long at birth. 25 to 26 inches at 6 months, and 
28 or 29 inches at 12 months. 

More rapid gains are noted in the first 6 months than in the second 
6 months. The average weekly gain is about 1 ounces. 

It sleeps soundly. 

Is happy, active, and enjoys using its arms and legs freely. 

Begins to follow moving objects with its eyes at the second or 
third month. 

Begins to sit unsupported at the seventh or eighth month. 

Cuts its first tooth from the sixth to ninth month; has about 6 
teeth at 12 months, 12 teeth at 18 months, 16 teeth at 21 months, and 
20 teeth at 30 months. 

Walks from the fourteenth to the seventeenth month. 

The soft spot or opening in the skull closes between the eighteenth 
and twenty-fourth month. 

Begins to say words like “ papa ” and “ mamma ” after the twelfth 
month, and simple, short sentences at the close of the second year. 
Children, however, that are otherwise perfectly normal may not 
begin to speak until a year later than the time stated above, or may 
present variations from any of the above. 

XIII. Contagious Diseases. 

The spread of most contagious diseases is caused through igno¬ 
rance or carelessness. Inasmuch as contagious diseases often can 
not be distinguished from the noncontagious, it is wise to separate 
children from every sick person, young or old, until the true nature 
of the illness is known. If the disease is contagious, the separation 
must be kept up. This separation consists in placing the patient 
in a room by himself and giving him separate wash cloths, tow^els. 
and dishes. One person only should care for the patient, and the 
clothing of this person should be protected by a gown or long apron 
or sheet when in the patient’s room. After caring for or handling 
the patient, the caretaker's hands should be carefully washed with 
warm water and soap. 

Every person should cooperate to the fullest extent with the local 
department of health in its efforts to limit the spread of communi¬ 
cable diseases. Do yourself what you wmuld desire of another parent 
whose child might be a source of danger to your own family. 

So-called colds, such as running nose, sore throat, bronchitis, and 
the like are easily communicated to children and may be especially 
serious for the baby. 

Do not sneeze or cough in the baby’s face. A mother should pro¬ 
tect the baby from catching her own cold by tying a handkerchief 
or piece of cheesecloth over her nose and mouth when nursing or 
caring for her baby. She should not kiss the baby. 


300 


PREVENTION OF DISEASE AND CARE OF SICK. 


Tuberculosis very often gets its start in infancy. Every effort, 
therefore, should be made to protect the baby from infection. Com¬ 
mon ways of infecting the baby are by kissing it, coughing or sneez¬ 
ing near the child, or by allowing it to sit on the floor where it has 
a good chance to pick up tuberculosis germs with the dust on its toys 
or other objects and thus get them into its mouth. It is a good plan 
to have a separate room or at least part of a room fenced off as the 
baby’s plavroom, and to cover the floor with a clean sheet each day. 
Milk from tuberculous cows may also be the cause of tuberculosis 
in the baby. 

Tuberculosis is sometimes very fatal in young children; the 
younger the child, the greater the danger. This disease causes a 
rapidly fatal form of meningitis and peritonitis, and the infant dies 
often in convulsions and without a diagnosis of tuberculosis having 
been made. 

Young children who are heavily infected with tubercle bacilli, 
even though they recover at the time of infection, are very likely to 
develop tuberculosis later in life at some period of stress due to 
overwork, undernourishment, or intercurrent disease, such as typhoid 
fever or influenza. 

It is absolutely imperative, therefore, to protect young children 
from infection. Infants should not be allowed to live in the same 
house or apartment with a consumptive. Either the consumptive 
should be removed, as to a hospital, or the baby should be taken care 
of in some other place. After the age of 5 years the danger is 
somewhat less; but precautions can not be too strict before that age. 

The danger of an adult person contracting tuberculosis from a 
consumptive is much less; in fact, this danger is so small that some 
physicians are inclined to say that the danger from such associations 
is negligible. 

XIV. Eye Disease and Blindness. 


Many babies within two or three days after birth, occasionallv 
later, have what is commonly known as “sore eyes” or, as the 
mothers say, “have caught cold in their eyes.” The proper name 
for this condition is ophthalmia, and it is caused by a germ getting 
into the eves during the baby’s birth. The evelids become reddened 
and swollen and in a very few hours pus is seen in abundance. All 
such cases must be energetically and skillfully treated at once bv 
trained physicians. Neglect and carelessness may result in the loss 
of the baby’s sight. The condition can usually be prevented if the 
physician puts a drop of a proper antiseptic in each eye immediately 
after the birth. (See p. 178.) 

XV. Vaccination. 


Do not forget that the earlier the child is vaccinated, the sooner 
it is protected against smallpox. In this country it is not possible 


PREVENTION OF DISEASE AND CARE OF SICK. 


101 


to know when and where an outbreak of smallpox will take place. 
It is well, therefore, to be prepared. 

The best time to have a baby vaccinated is in its first year. If 
the baby is healthy it may be vaccinated as early as the third or 
fourth month. 

XVI. Birth Registration. 


See that your doctor registers your baby's birth as soon as possible 
after it is born. Birth registration secures citizenship and may save 


future legal trouble. 


XVII. Prenatal Care. 


By this is meant the care and advice given to the mother before 
the birth of the babv in order that she mav fit herself to bear and to 
care for it. 

There is no doubt that the welfare of the baby depends largely 
upon the mother's health, and that many mothers would be better 
able to nurse their babies if they had proper care, food, clothing, and 
exercise before the babies were born. 

In order to secure the proper advice as early as possible every 
prospective mother should consult a physician as soon as she knows 
she is to have a baby. If she can not afford the services of a physi¬ 
cian, she should apply to a maternity hospital or dispensary where 
competent physicians and nurses are ready to advise and care for her 
until the baby is born. 

If, for any reason, the prospective mother can not see a competent 
physician at least once a month during her pregnancy she should 
send a specimen of her urine to him regularly each month. She must 
drink enough liquid so that she will pass at least 3 pints of urine each 
24 hours. Her bowels should move once a day. Persistent or sucl- 
den and severe headaches, swelling of the face or hands, increasing 
swelling of the ankles must be reported at once to the physician in 
charge. Any appearance of blood from the vagina demands instant 
summoning of the physician. As soon as a woman knows she is 
pregnant she should go to the dentist and have her teeth put in good 
condition. 

The above statements are the merest outlines of the fundamental 
care which every woman should have. It must be remembered that 
if the prospective mothers are intelligent!}* supervised and will re¬ 
port all untoward symptoms at once, deaths and disabilities of both 
mothers and children will be less frequent. 


CARE OF THE SICK. 


NURSING. 

The sick room should have two windows so that it can be easily 
aired. A narrow, high bed is better than a broad, low one. The 
sheets should be put on without wrinkles and should be frequently 
changed. A rubber sheet should be placed under the lower sheet 
if there is danger of soiling the mattress. When it is desired to 
put a sheet under a patient, it should be rolled up to half its width, 
the roll tucked under the patient, the latter turned over on the 
unrolled portion, and the sheet spread out. A folded sheet called 
a drawsheet is often placed under the patient’s hips. The nurse 
should wear clothes that can be laundered and she should keep 
herself scrupulously clean. It is well for her to have a pair of 
rubber gloves to put on when handling the bedpan or urinal. After 
performing duty of this sort she should immediately wash her 
hands and disinfect them with a bichloride solution 1 to 5.000 (one 
bichloride of mercury tablet, grains, dissolved in 5 pints of water). 
The patient should be given a sponge bath once a day for cleanliness, 
and his mouth should be frequently washed with a 4 per cent solu¬ 
tion of boric acid (5 teaspoonfuls of boric acid dissolved in a pint 
of warm water). Cold baths are sometimes used to lower the 
patient’s temperature. The .bedclothes are thrown off and cloths 
wrung out of cold water are applied to his body, or he may be 
wrapped in a sheet wrung out of cold water. A fan may be em¬ 
ployed to further cool the patient or ice may be rubbed over his 
skin. When the temperature has been reduced the bedclothes are 
again drawn over the patient. In some cases of kidney disease the 
hot pack is efficacious; a sheet is wrung out of hot water, the patient 
wrapped in it and the bedclothes immediately tucked around him. 
A hot foot bath is sometimes of service. A foot tub filled with hot 
water is put beside the bed. add a couple of tablespoonfuls of 
mustard previously stirred to a uniform cream in a cupful of hot 
water, place the patient’s feet in the bath and keep them there about 
20 minutes. The bath may be put in the bed if the patient is too 
sick to sit up. Hot-water bottles should never be more than half 
filled and should always be wrapped in a piece of flannel or blanket 
102 



PREVENTION OF DISEASE AND CARE OF SICK. 103 

and never allowed to come in contact with the patient’s skin. Great 
care should be taken not to burn the patient, a thing which may 
easily happen if he is unconscious. 

The nurse should see that the patient’s bowels move daily, and 
that he passes his urine. If he goes over 24 hours without urinating, 
a catheter should be passed. The method of doing this is described 
on page 157. A history should be kept showing the temperature, 
pulse, and respiration taken at least three times a day, the number 
of bowel movements and times urine was voided, baths given, and 
nourishment administered. 

The normal pulse rates is 72 to the minute, in a woman 80 a minute, 
in a child less than 1 year old from 105 to 120, 6 years old 90, over 
10 years 80 per minute. Considerable variation from this standard 
may, however, be compatible with health. It should be taken by 
laying the fingers gently on a superficial artery, preferably at the 
point where the radial artery passes over the wrist. The normal 
temperature taken with a Fahrenheit thermometer is 98.6°, with a 
centigrade 37°. A temperature from 99° to 101° is called a slight 
fever, from 101° to 103° a moderate fever, 103° to 105° a high fever, 
105° to 106° a very high, extremely dangerous, fever. In taking 
the temperature the following directions should be observed: 

Place bulb of mercurv in mouth under tongue for five minutes. If 
it registers over 101°, send for physician. Stay in bed until he 
arrives. See that it registers less than 97 before using. This may 
be brought about by shaking it. Grasp the thermometer at the 
middle between the index finger and the thumb of the right hand, 
hold the bulb downward and hit the lower edge of the right hand 
against the upper edge of the left hand; the column of mercury will 
be lowered bv the shock. 

4 / 

The normal respirations occur at the rate of 18 to the minute. 
In disease there are marked variations in the frequency and character 
of the respirations. They should be taken without the patient’s 
knowledge, as they are in a measure under the control of the will. 
This is done by laying the arm across the chest in taking the pulse, 
and then without removing the fingers from the wrist taking the 
respiration while appearing to take the pulse. 

In all acute diseases, especially those attended with fever, the 
question of diet is a very important one, and the main reliance may 
be placed on such food as eggs and milk. Thin soups may be used, 
but they contain very little nutrition and can not be depended upon 
to maintain the strength of the sick. 

A patient sick of a communicable disease should be isolated and 
some one detailed for his care and comfort, who, if practicable, 
should be immune to the disease. 


104 


PREVENTION OF DISEASE AND CARE OF SICK. 


Communication between the patient or his nurse and other persons 
should be reduced to a minimum. 

Used clothing, body linen, and bedding of the patient and nurse 
should be immersed in boiling water or in a 3 per cent solution of 
carbolic acid before removal from room, and should be kept so 
immersed for 1 hour. 

Eating and drinking utensils, after being used by the patient, 
should be washed in boiling water. They should not be used by 
others until they have been sterilized by boiling. 

The room from which the patient was removed should be disin¬ 
fected and thoroughly cleansed. 

Formulas for disinfecting solutions recommended for use. 


Bichloride of mercury 1 (1 t<> 1,000) : 

Bichloride of mercury (two 71-grain tablets)_grains_15 

Water_._quart_ 1 

Carbolic acid 1 (3 per cent) : 

Carbolic acid, pure_teaspoonfuls_ 3 

Hot water_pint_ 1 

Compound cresol (3 per cent) : 

Liquor Cresolis com posit us _teaspoonfuls_ 3 

Water_pint_ 1 

Bleaching powder: 

Bleaching powder (chloride of lime)_pound_ 1 

Water-gallons_ 4 


TYPHOID FEVER. 


Doses. —Unless otherwise stated, the doses mentioned in this book are in¬ 
tended for adults. To determine the dose for children, add 12 to the age of the 
child and divide the age of the child by this sum. This fraction will represent 
the size of dose compared with that of an adult. For example, a child 6 years 


6 


6 


old will require g , j 9 =^g or one-third of the adult dose. 

Caution. —Preparations containing opium, such as laudanum, paregoric, cam¬ 
phor and opium pills, Sun Cholera Mixture tablets, etc., should not be used 
except where absolutely necessary, as their continued use is liable to produce 
the drug habit. 


Typhoid fever is caused by a germ known as the bacillus typhosus. 
This bacillus is found in the discharges of persons sick with the dis¬ 
ease and sometimes for a considerable time after their recovery. 

«/ 

When the food or drink of well persons becomes contaminated with 
these discharges, typhoid fever is apt to result. This contamination 
ma} 7 be brought about by means of flies which convey small particles 
of fecal matter containing the bacillus of typhoid fever from privies 
to kitchens and dining rooms and soil the food by lighting upon it. 
Drinking water may become infected through the drainage of a cess- 


1 Poisonous solutions should ho colored blue with a little laundry bluing in order to 

distinguish them from nonpoisonous solutions. 














PREVENTION OF DISEASE AND CARE OF SICK. 


105 


pool into a well or near-by stream. Milk may carry the disease 
through the washing of milk cans with such water. Persons caring 
for typhoid-fever cases may infect themselves or others if they are 
not careful. Finally, there are patients who have recovered from the 
disease but who still have typhoid bacilli in their stools. These indi¬ 
viduals are called “ carriers ’’ and may cause sickness among many 
other persons. This is especially the case if they are employed in 
milking cows or in the preparation of food. 

Symptoms .—Typhoid fever begins with headache, diarrhea, cramps 
in the abdomen, nosebleed, loss of appetite, coated tongue, dry mouth, 
and fever, which is higher each day than on the day previous. The 
stools are foul smelling and of the color and consistency of pea soup. 
In mild cases some of these symptoms may be absent. As a general 
thing the patient has been feeling badly for several days before the 
attack begins. At the end of the first week the patient is dull and 
apathetic, twitches his fingers, and picks at the bedclothes. There 
may be a low muttering delirium. The abdomen is distended with 
gas, and small rose-colored spots appear here and there on the body. 
Later on there may be hemorrhage due to ulceration of the bowel. 
Sometimes an ulcer will perforate the intestine and allow its contents 
to enter the general abdominal cavity; this usually causes death in a 
few hours. When hemorrhage or perforation occurs there is severe 
pain and the signs of shock are present. The pulse is weak and 
thready, the face is pale, the skin damp, and the temperature falls to 
normal. Typhoid fever lasts from 4 to 7 weeks. Convalescence is 
slow. 

Abscesses and boils may form in various parts of the body, and 
bedsores are not uncommon. In persons who have used stimulants 
freely delirium tremens may be a prominent symptom. Pneumonia 
and meningitis are occasional complications. 

Prevention .—Wells suspected of being infected with sewage should 
be closed until it is proved that contamination has not taken place. 
Water that is suspicious, if it is necessary to use, should first be 
boiled or treated with bleaching powder, 1 teaspoonful to every 
500 gallons of water. The powder should be dry and only that 
taken from a freshly opened can should be used. During a typhoid 
epidemic milk should be pasteurized. This is done by heating the 
milk to 150° F. and keeping it at that temperature for half an hour. 
(See p. 90.) 

No person caring for a typhoid-fever patient should prepare food 
for others. The nurse should wash her hands carefullv after wait- 
ing upon the patient and before she eats her meals. After washing 
they should be immersed in a solution of bichloride of mercury (two 
7-grain tablets of bichloride of mercury to the quart of w r ater), or 


106 


PREVENTION OF DISEASE AND CARE OF SICK. 


a solution of bleaching powder, one-half teaspoonful to a quart of 
water, for a few minutes. The wearing of rubber gloves by those 
handling the patient is a good additional safeguard. Thorough 
scrubbing of the hands with soap and water only will do much 
toward removing the infection from the hands. 

All water used for bathing the patient should be disinfected b}^ 
adding 1 teaspoonful of bleaching powder to each gallon of water. 
The dishes and utensils used in caring for the patient should be 
immersed in bleaching-powder solution of the same strength as that 
employed for the hands. The urine and stools should be boiled or 
completely covered and thoroughly mixed with a bleaching-powder 
solution made by adding 1 pound of bleaching powder to 4 gallons 
of water. The mixture should be allowed to stand at least one-half 
hour before emptying into the water-closet. If there is no water- 
closet or sanitary privy about the residence, the discharges should be 
buried in the ground about 1 foot deep at a point remote from 
wells, springs, and other sources of water supply. The excreta, if 
deposited in the ground, should be thoroughly covered with earth 
to prevent chickens and other animals from having access to it. 
All towels, sheets, and other cloths used about the patient should 
be boiled or disinfected with bleaching-powder solution. Persons 
who have had typhoid fever should not be permitted to handle food 
until they have been proved free of typhoid germs by a microscopical 
examination. 

Typhoid prophylaxis .—When typhoid fever is prevalent everyone 
should be inoculated with antityphoid vaccine to prevent taking the 
disease. This vaccine has practically eliminated this disease from 
the Army. During the fiscal year 1916 there were 2.20 cases of 
typhoid fever among seamen, of whom 31 died; if this vaccine had 
been administered to these men before they were taken sick, it is 
safe to sav none of them would have had the fever. An attack of 

4 / 

typhoid fever usually lasts two months, and the patient is as a rule 
too weak to do much work for another month, so that at least 75 days 
are lost bv each attack of this disease. From the above calculation 
it will be seen that this would amount to 16,500 days’ sickness for 
those that survived. 

Treatment .—Place the patient in bed and do not let him get up. 
When he desires to have an action of the bowels, the bedpan should 
be used. *He should have a liquid diet, plenty of water, milk, and 
thin soups, which should be given in liberal quantities, a cupful 
every two hours: no solid food should be allowed until 10 days after 
the fever has subsided. The temperature should be watched and the 
patient bathed with cold water whenever the fever rises above 39° C. 
(102.2° F.). Ice bags, if obtainable, applied to his abdomen and 
chest will assist in keeping the temperature down. One should also 


PREVENTION OF DISEASE AND CARE OF SICK. 


107 


be applied to the head if there is delirium. If there is distension of 
the abdomen hot turpentine stupes should be applied. This is done 
by wringing a double layer of thin flannel out of hot water with 
which a teaspoonful of turpentine has been mixed. An injection of 
a pint of warm water containing a teaspoonful of turpentine is also 
beneficial. The bowels should be kept open by injections of warm 
soapy water. In case of collapse give coffee or inject hot coffee or 
salt solution (one teaspoonful of salt to a pint of water) into the 
bowel. 

TYPHUS FEVER. 

Typhus fever, also known as hospital fever, spotted fever, jail 
fever, camp fever, Tabardillo, and ship fever, is a disease which 
causes great mortality when it becomes epidemic among persons 
infested with lice. The cause of the disease is probably the Rickettsia 
prowazeki. It is transmitted by the body louse. 

Symptoms .—Incubation period is less than 12 days. The symp¬ 
toms resemble those of typhoid fever but the onset is much more 
abrupt. It begins with a chill, headache, and pains in the back and 
legs; there is marked prostration so that the patient has to go to bed 
at once; there is high fever from the beginning, the tongue is furred 
and white, the face is flushed, and the bowels are constipated. 
Nervous symptoms are pronounced; the sick person may lie with his 
eyes open but be in an unconscious condition; he may pick at the 
bed clothes; there may be intense delirium, the patient trying to get 
out of bed. The eruption appears on the third to the fifth day; it 
consists of a number of dark red papules; there may be small hem¬ 
orrhages under the skin. The rashes and the hemorrhages give the 
skin a curiously mottled appearance. The fever generally falls 
suddenly about the fourteenth daj’’. In favorable cases it does not 
return, but preceding a fatal termination it may again rise very high. 

Prevention .—It is necessary to be sure that all lice and their eggs 
on the patient’s body and clothes are killed. It is better to remove 
the patient’s clothing in an outer room. His body should then be 
annointed with a mixture composed of one-third gasoline and two- 
thirds vaseline. His hair should be soaked in a mixture of equal 
parts of vinegar and kerosene and his clothes wrapped in a sheet, 
after which they should either be destroyed or sterilized by boiling 
or steaming (see p. 58). The patient should then be put to bed in 
another room and the room in which he undressed should be scrubbed 
with a hot solution (3 per cent) of compound cresol solution (see 
p. 104). The body and clothing of persons who have lived with the 
sick man should be treated in the same manner. The doctors and 
nurses should take special precautions to prevent being bitten by 


108 * PREVENTION OF DISEASE AND CARE OF SICK. 

lice; they should wear rubber gloves and completely cover their 
bodies with gowns when going near the patient ; a tight fitting cap 
should be worn so as to entirely cover the hair. 

Treatment .—Patients are best treated in tents in the open air. 
There not only seems to be less liability of other persons becoming 
infected under these conditions, but it is much more beneficial to the 
patient. Sponge baths should be frequently given to keep the tem¬ 
perature as low as possible. An ice bag applied to the head is often 
of value. The bowels should be kept open by giving small doses of 
salts. The patient should be fed every two hours, being given a 
half glass of milk or a small bowl of soup. Water should be given 
freely and small pieces of ice allowed to dissolve in the mouth. 

DYSENTERY. 

% 

Dysentery, or bloody flux, as it is sometimes called, is an affec¬ 
tion —an inflammation and ulceration—of the mucous membrane of 
the large bowel. It occurs in different degrees of severity. It may 
be acute or chronic. There are different varieties. Its severest form 
is met with in tropical countries, where it frequently occurs in wide¬ 
spread epidemics. Epidemics also occur in temperate regions. Spo¬ 
radic cases may be found almost everywhere. The disease prevails 
in summer and autumn. 

Bad food, unripe fruit, impure drinking water, exposure to cold 
and dampness, while probably not in themselves the direct cause of 
dysentery, doubtless favor the operation of other causes. 

/Symptoms .—The onset may be sudden or gradual. There may or 
may not be chills or chilliness. There is usually some feverishness. 
The tongue is furred and moist, but soon becomes red and dry or 
brownish and glazed. 

The first stools may be like those of an ordinary diarrhea. After 
a day or two, or maybe within a few hours, these are replaced with 
small mucous stools frequently mixed with blood and small particles 
of fecal matter. Soon the evacuations consist of mucus alone, or of 
blood and mucus, or of a jellylike matter and small white clumps 
of mucus. Later they may be shreddy, and brownish or greenish 
in color. The jDatient complains of cramps and “ colicky ” pains in 
his belly, a burning sensation in the rectum, with a feeling as if some¬ 
thing must be expelled, and of a constant desire to go to stool. The 
evacuations may number from 10 to 20, or 40 to 50, or even 100 or 
more a day, according to the severity of the case. The quantity of 
each may not exceed a teaspoonful. 

In mild cases there is a gradual change to normal, and patient may 
recover after a period of a week or 10 days. Severer cases continue 
for several weeks or longer and then recover or become chronic. 
Death may occur from general weakness. 


PREVENTION OF DISEASE AND CARE OF SICK. 109 

Tropical dysentery, the variety which occurs most frequently and 
in epidemic form in tropical or subtropical regions, but also occa¬ 
sionally in temperate climates, is produced by a microorganism which 
enters the system in drinking water or food contaminated by the 
hands of those who have the disease. 

The symptoms in this form of dysentery are similar to those 
already described. The burning sensation and bearing-down pain, 
however, are less marked. The stools are less frequent, but they are 
larger and more watery—at times more like diarrhea than typical 
dvsenterv. The disease in favorable cases runs a course of from 6 
to 12 weeks. Recovery is always slow. Death may occur from ex¬ 
haustion or from abscess of the liver, which is a common complica¬ 
tion. In some epidemics the course of the disease is rapid. 

Prevention .—In tropical climates or in places where the disease 
abounds water should be boiled before drinking, or it should be dis¬ 
infected in accordance with the method described on page 25. As 
persons who have had the disease may still have the germ in their 
stools without showing any symptoms, care should be taken to ex¬ 
amine all persons who handle food, as such persons may transmit the 
disease to other persons. The precautions described under typhoid 
fever should be taken by a person caring for a patient suffering from 
dysentery in order to prevent its spread. 

Treatment .—Rest in bed. If possible, the patient should use the 
bedpan instead of the commode or closet, so as to insure the greatest 
amount of rest, which is important. Stop all solid food. Give 2 
tablespoonfuls of castor oil and 15 drops of laudanum in one -dose, 
and, if necessary, repeat the dose in six hours, or give smaller doses 
at intervals of four hours. After the bowels have been thoroughly 
cleared out, a pill of camphor and opium should be given every three 
hours. Hot applications should be placed on the abdomen. The 
bearing-down pain and the burning sensation may be relieved by 
washing out the rectum with a pint of warm water and by injecting 2 
ounces of thin starch containing 25 or 30 drops of laudanum. 

In place of the castor oil, Epsom salt may be given in tablespoon¬ 
ful doses, repeated every two hours until a free and large action of 
the bowels results, and then the pill of camphor and opium given 
every three hours. Or, instead of the camphor and opium pills, 
bismuth subnitrate may be given in 30 or 40 grain doses. 

After two or three days, if the disease continues, the castor oil or 
the Epsom salt may be repeated, and after its effect is produced the 
same line of treatment continued. 

The diet should be limited to the lightest articles, such as thin por¬ 
ridge, milk, and broths. And even in the lightest cases the patient 
should be kept warm in bed. 


110 


PREVENTION OF DISEASE AND CARE OF SICK. 


Tropical dysentery should be treated by injections into the bowel 
of large amounts of cold water (45° F.) containing 1 part of sulphate 
of quinine to 5,000 parts of water (3 grains of sulphate of quinine to 
1 quart of water). Three-grain doses of emetine bismuth iodide given 
by the mouth every night before retiring for 12 nights is, however, 
the best treatment. When this drug can not be obtained salol-coated 
capsules of powdered ipecac may be used instead. 

PNEUMONIA. 

When a person suddenly has a severe chill followed by a high 
fever, flushed face, difficult breathing, and a pain in his chest, he 
may be suffering from pneumonia, and as this is a dangerous disease 
the services of a physician should be obtained at once. 

Causes .—The disease is due to a germ known as the pneumo¬ 
coccus. It is a constant inhabitant of the throats of healthy people 
and apparently does no harm until the resistance of the body is 
lowered by disease, lack of food, drunkenness, or exhaustion due to 
severe physical exercise. Persons frequenting badly ventilated stores, 
factories, theaters, street cars, or other places where there are crowds 
are liable to contract pneumonia. Chilling of the body when over¬ 
heated may bring on an attack. Many elderly persons suffering 
from chronic diseases die of pneumonia, the disease being often 
spoken of then as a terminal pneumonia. 

Symptoms .—The sputum is abundant, tenacious, and of a reddish- 
brown color, whence the name “ rusty sputum.” The color is due 
to the admixture of small quantities of blood. The pulse at first 
is full and bounding, but later may become weak, rapid, and barely 
perceptible at the wrist. Breathing is embarrassed, the respiratory 
movements are rapid. 30 to 50 per minute, the patient is restless and 
often can not lie down but has to be propped up in bed or sit in a 
chair. There may be delirium, and if not watched the patient may 
jump out of a window and injure himself severely. The fever in 
a typical case remains high until the seventh or ninth day, when it 
will frequently drop to normal in a few hours. This is called the 
crisis, and if there are no complications it is followed by great im¬ 
provement in the patient’s condition and he generally goes on to 
recovery. In other cases the temperature does not return to normal, 
but only falls a degree or two for a short time and then rises again. 
This is called the false crisis and is of unfavorable import, especially 
if accompanied by profuse sweat and blueness of the skin. 

Complications .—The disease is nearly always accompanied by 
pleurisy, which is an inflammation of the serous membrane covering 
the lung. This is the cause of the pain in the side. There also may 



Fig. 82.—Pneumonia pneumococci, sputum 
preparation, a, Isolated cocci; b, in 
cham form. 


Fig. 83.—Influenza bacilli; sputum 
preparation. 




Tig. 84.—Follicular type of diphtheria, 
child 7 years old, seen on second day 
of illness. The membrane involved 
the lacunae of tonsils. Note close 
resemblance to follicular tonsilitis. 




FiG. 85.—Septic type of diphtheria, 
child 8 years old, seen on the fifth 
day of illness. The pseudomem¬ 
brane in this case covered the hard 
palate and extended in a large 
mass down the pharynx, com¬ 
pletely hiding the tonsils. 



FiG. 86.—Antitoxin has reduced the diphtheria 
~ mortality from about 45 percent to less than 
10 per cent. 


Fig. 87.—Smallpox. Tenth day 
of eruption. (By Welch and 
Schamberg.) 

























Fig. 88.—Well-pronounced, discrete 
smallpox in an unvaccinated sub¬ 
ject on the eighth day of eruption, 
showing the relative sparsity of 
lesions on the trunk. 


Fig. 89.—Revaccination in an adult, showing 
t he vesicles upon the eighth day. (By Welch 
and St'hamberg.) 



Fig. 90.—Smallpox. Mother and daughter. 
Bhe daughter, through vaccination, 
although exposed, did not contract the 
disease. 


Fig. 92.—A severe attack of chicken 
pox, showing lesions in various 
stages of development (fourth 
day). K elative sparsit y of lesions 
on the face as compared with the 
trunk. (By Welch and Scham- 
berg.) 















PREVENTION OF DISEASE AND CARE OF SICK. 


Ill 


be inflammation of the membranes covering the heart, brain, or 
spinal cord, causing special symptoms due to injury of these 
structures. 

Prevention .—Do not expose yourself to a draft when overheated. 
[When chilled do not drink whisky or other alcoholic beverage, as 
the liability to contract pneumonia is increased by alcohol, for 
although it gives a feeling of well-being, the temperature of the 
bod} 7 is lowered and the power to resist disease is diminished by its 
use. A cup of hot tea or coffee, on the other hand, is beneficial and 
helps to restore the body to its normal condition. It should be 
remembered that pneumonia is a communicable disease, and that 
it may attack nurses and those who are waiting upon the patient. 
This is especially liable to happen if the room is poorly ventilated. 
The nurse should wear a gauze mask and be careful that the patient 
does not breathe in her face. Her hands should be disinfected with a 
solution of bichloride of mercury, 1 to 2,000 (one 7J grain tablet of 
bichloride of mercury to 1 quart of water), or other disinfectant, 
after waiting upon the patient. All dishes, utensils, towels, sheets, 
and other articles used by the patient should be boiled or disinfected 
with a solution of bleaching powder (one-half tablespoonful of 
bleaching powder to a quart of water). Compound cresol solution 
should be used to disinfect the sputum. 

Treatment .—The essential thing in the treatment of pneumonia 
is to see that the patient gets plenty of cold fresh air. Oftentimes 
no other treatment is necessary. The bed should be placed upon 
a porch, or, if this is impossible, all the windows of the sick room 
should be wide open. The patient should be well covered, and hot- 
water bottles or hot bricks should be placed near his feet to keep 
them warm, care being taken not to burn him. Once a day the 
patient should be moved to a warm room and given a sponge bath. 
The pain in the side can be relieved by a mustard plaster (p. 310). 
Two grains of calomel and four grains of sodium bicarbonate, fol¬ 
lowed in about 6 hours by a Seidlitz powder, should be given on 
the first day, and the bowels should be kept open thereafter by a 
small dose of salts given each day. The patient’s strength should be 
conserved by giving him a glass of milk or a bowl of soup every 
two hours during the day, and also at night when he is not sleeping. 
Solid food should not be given, as it will cause gas in the stomach, 
which may press against the heart and seriously interfere with its 
action. Milk is the best food, but sometimes it produces gas, in 
which case soups alone should be used. 

49671 °—23-9 +10 



112 


PREVENTION OF DISEASE AND CARE OF SICK. 


INFLUENZA. 

This disease begins like a cold. There are pains in the head, eyes, 
and limbs; a watery discharge from the nose, chilly sensations, sore 
throat, cough, and extreme muscular prostration. The sputum is of 
a dirty yellowish color. There may be abdominal symptoms such as 
nausea, diarrhea, vomiting, and cramps. There is fever, which 
varies according to the intensity of the disease. There are many 
varieties of the disease, and any organ of the body may be attacked. 
Pneumonia is a frequent complication. 

Prevention .—Care should be taken that no one suffering from the 
disease coughs in your face. Keep away as much as possible from 
such persons. A cold in the head or on the chest may be due to the 
influenza bacillus, so do not sleep with persons suffering from these 
conditions. Wear a mask made of several layers of gauze when nurs¬ 
ing a person suffering from this disease. 

Treatment. —Aspirin, 5 grains every three hours, often relieves the 
pains. A mild purgative, such as a Seidlitz powder, should be given. 
The tendency to diarrhea should be remembered, so strong purga¬ 
tives such as salts should not be administered. When there is pain 
in the abdomen a camphor and opium pill is of value. A light diet 
such as milk and soups should be taken. Steaming the nose and 
throat by inhaling steam from a teapot filled with hot water into 
which a small lump of camphor has been dropped will relieve to 
some extent the congestion of those structures. 

ERYSIPELAS (ST. ANTHONY’S FIRE). 

Erysipelas is an inflammation of the skin. It usually begins with 
a chill, followed by a high fever. It is a complication of wounds, 
but is more frequently developed without any apparent injury. A 
large majority of cases begin on the face, usually on the nose, first 
as a small red spot, which is soon elevated above the surrounding 
skin, and gradually or rapidly spreads over the face and ears, and 
not infrequently over the entire hairy scalp; sometimes over the 
neck and chest, and occasionally down the back, and to other parts 
of the body. The skin is red, hot, painful, and swollen, and blisters 
frequently form. The swelling may be most marked about the eyes 
and ears, the eyes closed, and the patient’s features changed and 
distorted to such a degree that the appearance once seen will not 
soon be forgotten. The disease, if limited to the face and scalp, 
usually runs its course in a few days or a week, but sometimes before 
the face is healed red spots appear on other parts of the body, and 
the case may be prolonged. Abscesses beneath the skin are not un¬ 
common. 


PREVENTION OF DIBEASE AND CARE OF SICK. 


118 


Besides the symptoms already mentioned there are headache, loss 
of appetite, coated tongue, frequently vomiting, and in some cases 
delirium and marked depression. 

The outcome is usually favorable, but in drunkards or in persons 
debilitated from previous diseases death is sometimes the result. 

Prevention .—Erysipelas is only slightly contagious under ordinary 
circumstances, but persons suffering from wounds or scratches of the 
skin are very apt to be attacked. The patient should, therefore, be 
isolated—placed in a room by himself—and his attendant should be 
a healthy person free from any skin injury. Wounds should be care¬ 
fully dressed with antiseptic solutions to prevent the development of 
erysipelas. 

Treatment .—The disease is self-limited, recovery usually taking 
place in from 12 to Id days. The bowels should be kept open and 
the strength supported by feeding the patient frequently—every two 
or three hours. The diet should be light and consist of milk, broths, 
puddings, etc. If the temperature rises above 103° F., the patient 
should be given a cold bath. The eyes should be frequently washed 
with a 4 per cent solution of boracic acid (boracic acid 4 parts, hot 
water 100 parts). Cloths wet with boracic acid may be also placed 
upon the skin or an ointment of 10 parts of boracic acid and 90 parts 
vaseline spread upon a clean cloth may be used in its stead. Blisters 
that form should be pricked with a needle and the water allowed to 
drain off, but the skin should not be disturbed. 

DIPHTHERIA. 

Diphtheria is a communicable disease, due to the action of the 
bacillus diphtheriae. When conditions are favorable this germ causes 
an inflammation of the lining membrane of the throat, upon which 
a grayish fibrinous exudate forms. The constitutional symptoms of 
the disease are the result of the absorption into the circulation of 
toxins or poisons produced at the site of the lesion. The grayish 
exudate is usually on the tonsils and palate, but it may extend up 
into the nose or dowm into the windpipe. A raw bleeding surface 
is left when a portion of this exudate or false membrane is detached. 
Efforts at swallowing cause strangulation or choking, and the patient 
may become asphyxiated by the exudate membrane blocking up the 
larynx. The voice is often husky, and there may be a rough cough, 
to which the term “ croupv ” has been applied. In severe cases there 
are high fever and great prostration. 

Sequelce .—Paralysis may follow diphtheria. This may be slight, 
only affecting the palate, giving the voice a nasal character, or severe, 
nearly all the muscles of the body being involved. Weakness of the 
heart sometimes causes death as late as the sixth or seventh week. 



114 


PREVENTION OF DISEASE AND CARE OF SICK. 


Nephritis may be one of the complications of the disease, but dropsy 
is less common than after scarlet fever. 

Diagnosis .—Whenever a grayish exudate is seen on the throat 
diphtheria should be suspected, especially if much inflammation is 
present and if bleeding occurs when a piece of the false membrane is 
detached. Diphtheria examination packages are now supplied free 
by most drug stores. These packages hold two glass tubes, one of 
which contains blood serum and the other a sterile swab. The tubes 
are closed by cotton plugs. These should be removed, the swab 
wiped over the throat, and then gently rubbed over the blood serum. 
The swab should then be replaced into its own tube, the cotton plugs 
of both tubes replaced, and the tubes mailed to the health officer of 
the city or district. A postal card will be mailed by him the next 
day to the sender stating whether or not the person from whom the 
specimen was taken has diphtheria. 

Prevention .—School teachers should watch the children under their 
care; and if one complains of sore throat or has a croupy cough, the 
school physician should be requested to make an examination of the 
child to determine if these symptoms are due to diphtheria. All 
persons suffering from this disease should be quarantined, and those 
who have been exposed to it and respond to the Schick test should 
be given a small dose of diphtheria antitoxin (1,000 units) as a pre¬ 
ventive measure. The Schick test, which can be made by any physi¬ 
cian, shows if the child has a natural immunity against the disease. 
No protective dose need be administered to a child having this immu¬ 
nity. When diphtheria is prevalent school children should be exam¬ 
ined to ascertain if there are diphtheria germs in their throats, as 
these germs may be present without causing the disease. Such per¬ 
sons, known as diphtheria carriers, may, however, communicate the 
disease to other persons, and therefore should be excluded from the 
schools. 

Treatment .—As soon as it is suspected that a person has diphtheria 
a physician should be sent for, if possible, as it is important that 
diphtheria antitoxin should be administered to the patient at once. 
If this serum is given in sufficient quantities (5,000 to 10,000 units) 
early in the disease, the symptoms disappear like magic. The fever 
subsides, the inflammation in the throat abates, the exudate is cast off, 
and the tissues heal promptly. The dose of antitoxin should be 
repeated in a few hours if the fever continues. Some cases, where 
the disease has remained untreated for several days, require large 
quantities of antitoxin (80,000 to 90,000 units). Where antitoxin 
can not be obtained the patient should be given stimulants, cold 
compresses should be applied to the neck, and the throat should be 
frequently swabbed with the following solution; Carbolic acid, 3 


PREVENTION" OF DISEASE AND CARE OF SICK. 


115 


parts; water, sufficient, to make 100 parts. Calomel, one-fourth 
grain every two hours, is recommended by some physicians, but the 
patient is liable to become salivated. The room should be warm, a 
window partly open for ventilation, and the air kept moist by 
making a hood with a sheet placed over a frame on the bed and 
allowing the steam from a kettle to pass under it. A liquid diet 
should be given, and when impossible for the patient to swallow 
he should be fed by the rectum. If there is obstruction of the larynx 
and the patient is blue in the face, intubation or tracheotomy has to 
be performed. In the first operation a special hollow tube with a 
thread attached is inserted in the larynx, being guided in place by 
the finger. If no intubation tube is available, recourse should be had 
to tracheotomy. The physician grasps the windpipe between the 
forefinger and thumb of the left hand, pushes the other tissues of the 
neck to each side, and opens the windpipe in the middle line. All 
bleeding should be stopped by artery forceps or ligatures before 
windpipe is opened. This operation requires some skill and should 
not be performed except as a last resort. The patient should not be 
allowed to mingle with other persons until a culture has been taken, 
as described under “ Diagnosis,” and sent to the city or State depart¬ 
ment of health and found to be negative—that is, no germs of 
diphtheria present. The room and its contents should then be dis¬ 
infected, as described under the heading “ Measles.” 

RHEUMATISM. 

There are different forms of rheumatism, and some of the forms 
have several different names. Acute rheumatism, acute articular 
rheumatism, inflammatory rheumatism, and rheumatic fever are 
terms applied to one and the same disease. A milder form of the 
affection is called subacute rheumatism. In this form the symptoms 
are less severe, but the disease is more prolonged. It may continue 
for a long time and become chronic. Chronic rheumatism, however, 
or the different affections and deformities of joints to which this 
term is frequently applied, may develop independently of any acute 
or subacute attack. 

The term muscular rheumatism indicates an affection of the mus¬ 
cles as distinguished from joint affections. Lumbago and stiff neck 
are varieties of muscular rheumatism. The muscles, however, to 
a greater or less extent, may be involved in any form of rheumatism. 

Other conditions simulating rheumatism, occurring in connection 
with or directly due to gonorrhea or to syphilis, are called gonor¬ 
rheal rheumatism or syphilitic rheumatism, as tho case may be. 

Rheumatism, either the acute or the chronic form, may be due to 
the absorption of germs, or poisons produced by them, from abscesses 



116 


PREVENTION OF DISEASE AND CARE OF SICK. 


at the roots of the teeth, or infections in the tonsils, nasal passages, 
or other parts of the body. 

Prevention .—The early removal of adenoids and diseased tonsillar 
tissue may prevent not only attacks of rheumatism, but inflamma¬ 
tion of the valves of the heart, leading to impairment of that organ 
in after life. The child’s teeth should be carefully examined by a 
dentist, X-ray plates being taken if necessary to discover if there are 
any abscesses around the roots. Such abscesses should be drained to 
prevent the absorption of poisons which may be the cause of the 
rheumatism. 

Acute Rheumatism (Rheumatic Fever). 

This is a comparatively common disease in all climates within 
the Temperate Zone. It occurs chiefly during the winter and spring. 
Exposure to a cold, damp atmosphere is the most frequent exciting 
cause in persons predisposed to the disease. 

It may or may not begin with a chill or with a sore throat. The 
larger joints are usually affected. Swelling, heat, redness, tender¬ 
ness, and pain are the chief symptoms. The inflammation is apt to 
shift from one joint to another. The pain and fever are usually 
increased in proportion to the number of joints involved. The ma¬ 
jority of cases are attended with profuse perspirations, scanty, highly 
acid urine, coated tongue, and constipation. The heart is frequently 
involved. 

In treating, wrap the joint in cotton or flannel; keep it very quiet— 
the slightest movement aggravates the pain. Flannel wrung out of 
hot water and applied to the joint sometimes affords relief. A lini¬ 
ment composed of 10 to 50 per cent of oil of wintergreen in olive oil 
may be applied on a piece of flannel if the pain is severe, or cold 
applications may be employed if agreeable to the patient. 

Place the patient in a good bed, and let him wear flannel next to 
his skin. Change the flannel frequently, and bathe the body with 
tepid water. 

For internal medication give salicylate of soda or aspirin in doses 
of 10 grains every two hours until about eight doses are taken or 
the pain is relieved; then give it in smaller doses of from 3 to 5 
grains every six hours. 

The food should be soft and nourishing and given every three 
hours. Epsom salt should be given to keep the bowels open. The 
patient should be kept in bed for a few days after the symptoms 
have subsided. The duration of the disease is very uncertain. The 
acute symptoms may subside in a few days and the patient may be 
up and about in a week or 10 days, but relapses are common, and 
the acute may pass into the subacute or chronic form. 


PREVENTION OF DISEASE AND CARE OF SICK. 


117 


Chronic Rheumatism. 

In chronic rheumatism there is stiffness and pain. A cracking or 
gTating sound is frequently produced when the joints are suddenly 
moved. In severe cases the joints become enlarged and distorted. 
The deformity is sometimes very great. 

The treatment consists chiefly in local application of liniments, 
etc., which afford relief because of the rubbing (massage) by which 
they are applied. Severe pain in the joint may be relieved by cold 
applications (flannel wrung out of iced water, applied to the joint 
and covered with muslin). Hot applications to the joints are some¬ 
times of value. Belladonna plaster may be applied. 

Five to eight grains of iodide of potash in a glass of water may 
be given three times a day between meals. 

The general health should be looked after. The skin should be 
kept in good condition by frequent baths of tepid water. The 
bowels should be moved at least once a day. Patient should be 
allowed good food. Fresh air is also important. 

Muscular Rheumatism. 

In this disease the muscles most frequently affected are those of 
the back (lumbago), side of neck (stiff neck or wry neck), and side 
of chest (pleurodynia). Exposure to cold, sudden cooling of the 
body—especially after active exercise and sitting in a draft of air— 
are the chief causes or exciting causes. 

. As a rule there are no symptoms other than the stiffness and pain 
on motion. The muscles may be slightly swollen and very sensitive. 
Some times the attacks come on suddenly and apparently without 
cause, or following a slight twist or strain, as a “ kink in the back.” 
or patient may wake up in the morning with a stiff neck. 

In treating acute cases salicylate of soda or aspirin may be given 
in 5 or 10 grain doses every three hours until four or six doses are 
taken. Apply hot applications, dry heat, hot-water bag, or a hot 
poultice locally, or the heat may be applied by a flatiron over folds 
of flannel or a piece of blanket and the rheumatism “ ironed out.” 
Later apply liniment with friction (massage). Keep the affected 
muscles at rest. If the muscles of the chest are affected, apply 
strips of adhesive plaster, the same as for fractured rib. Acute 
attacks are of short duration, but relapses are not uncommon, and 
chronic forms are frequently met with. Good food, fresh air, and 
attention to the general health are especially important in the treats 
ment of chronic muscular rheumatism. 


118 


PREVENTION OF DISEASE AND CARE OF SICK. 


Gonorrheal Rheumatism (Gonorrheal Inflammation of Joints). 

This may occur during an acute attack of gonorrhea, but it is more 
frequently associated with chronic gonorrhea or gleet. One or sev¬ 
eral joints may be affected. There may or may not be considerable 
fever. If only one joint is affected, it is apt to be the knee or the 
ankle. In chronic cases the pain is sometimes centered in the heel. 
The attack may begin in the wrist, elbow, or shoulder. The disease 
is not always limited to the joints. Sometimes the inflammation is 
in the tissues outside the joint proper, in the sheaths of the tendons 
of muscles, or in the fascia of the soles of the feet. The swelling is 
frequently quite marked. In chronic cases there may be effusion 
(“water on the joint”). In very severe cases suppuration occurs 
(abscess forms). The eye and the heart may also be seriously 
involved. 

Treatment is not very satisfactory. Keep the joint at rest. Apply 
a flannel bandage. Change it frequently and wash the joint with hot 
water and soap. In chronic cases liniments and passive motion 
should be applied. Tincture of iodine may be painted over the joint. 
A few drops of oil of wintergreen rubbed gently on the joint before 
the application of a bandage will often allay the pain. Aspirin, 10 
grains every 3 hours, may be given if the pain is severe. 

Syphilitic Rheumatism. 

This so-called rheumatism is associated with secondary or tertiary 
syphilis. The joints and the shafts of long bones may be affected— 
thickened and painful. The pain is always worse at night. 

The treatment is by iodide of potash, beginning with 10 grains of 
iodide of potash three times a day between meals. Good food should 
be given and the bowels kept open. (See p. 152.) 

SMALLPOX. 

Smallpox is an acute, contagious disease, characterized by an 
initial fever and successive stages of eruption. It spreads rapidly 
among persons unprotected by vaccination. It may be communi¬ 
cated by the breath, by exhalations from the skin, by clothing, or by 
anything that has been in contact with a person suffering from the 
disease. 

After a period of incubation of from 8 to 14 days, occasionally 
longer, the disease begins suddenly, usually with a chill, always with 
severe pain in the back and loins, intense headache, and high fever. 
Vomiting occurs in many cases. The bowels may or may not be con¬ 
stipated. About the end of the third day or on the fourth day a pap¬ 
ular eruption appears on the forehead, and frequently on the lips and 
the wrists, occasionally in the mouth and throat, and gradually ex- 


PREVENTION OF DISEASE AND CARE OF SICK. 


119 


tends to other parts of the body. The eruption begins as a bright red 
dot or spot slightly elevated above the surrounding skin, enlarging 
until the second day, when it forms a papule. The papule is hard to 
the touch, feels like shot under the skin. As soon as the eruption ap¬ 
pears the temperature begins to fall, and the distressing symptoms 
subside. On the fifth or sixth day a small vesicle, with a depression of 
the center, appears on the top of the papule. The vesicles gradually 
become distended, the depressed center rounded out, and about the 
eighth or ninth day the change is completed and the vesicles become 
pustules. They have a yellowish gray appearance and each pustule 
is surrounded by a red border. The skin between them is swollen, 
the eyes may be closed. During this change the temperature rises 
again, secondary fever sets in, the chief symptoms return, and a day 
or two later another change begins. The pustules break, matter oozes 
out, crusts form, first on the face and then over other parts of the 
body, following the order of the appearance of the eruption. The 
secondary fever may be quite high in the beginning, but gradually 
declines as the pustules change into crusts, and in favorable cases 
seldom lasts more than two or three days. The crusts then rapidly 
dry and fall off, leaving red spots on the skin and here and there the 
characteristic pockmarks or pits. The healing of the pustules is 
usually attended by troublesome itching. 

In some cases a diffuse redness of the skin or red spots appear on 
the abdomen, or on the side of the chest, or on the inner surface of 
the thighs as early as the second day, but the distinctive papular 
eruption makes its appearance, as stated, at the end of the third or 
on the fourth day and nearly always begins on the forehead. 

In the confluent form of smallpox the eruption may appear a day 
earlier and all the symptoms are more severe. The pustules run 
together and form large brownish scabs, chiefly on the face and head*, 
but also on the hands and feet. The face and neck are greatly swol¬ 
len, the eyes are closed, the features are distorted. The patient com¬ 
plains of tension and burning of the skin; there is much thirst. The 
eruption may also appear in the mouth and throat. The secondary 
fever is high. Delirium may be quite marked. In fatal cases the 
pulse becomes rapid and feeble, and death occurs about the tenth or 
eleventh day or later. 

In favorable cases, about the eleventh or twelfth day the pustules 
begin to break. The matter dries and forms crusts which slowly fall 
off, leaving the skin quite red and in many cases dreadfully scarred 
and pitted. 

The crusts begin to drop off about the fourteenth day, but the proc¬ 
ess of desquamation may not be completed until the end of the third 
or fourth week, and the fever may persist during that period. There 
is a milder form of smallpox called varioloid, in which the symptoms 


120 


PREVENTION OF DISEASE AND CARE OF SICK. 


are usually milder and of shorter duration. \ arioloid occurs in per¬ 
sons who have been vaccinated. Sometimes the eruption begins on 
the feet. In some cases it is confined to the feet and hands. Oc¬ 
casionally the eruption is extensive and the symptoms are severe. 

The most severe type of smallpox is the hemorrhagic (bloody). It 
occurs in two forms. In one the case goes on in the usual way until 
about the ninth or tenth day, when blood makes its appearance in the 
pock. This form is sometimes called black smallpox. In the other 
form the eruption may be blood colored from the second day, and 
bleeding may take place from the nose or mouth or from the rectum. 
The face is greatly swollen and the eyes are deeply bloodshot. Death 
occurs during the first week, sometimes as early as the second day. 

Before the characteristic eruption appears it is frequently very 
difficult to determine the existence of smallpox. It is easily con¬ 
founded with other eruptive diseases. The important points to re^ 
member are the intense pain in the back, the high fever, and 
bounding pulse, all of which precede the eruption, and that when 
the eruption appears the fever and all the severe symptoms subside. 
The temperature before the eruption may be up to 105° or 106° F. 
(40.5° or 41.1° C.). When the eruption appears it begins to decline 
and within 24 or 36 hours is down to about 100° F. (37.7° C.). When 
the secondary fever sets in the temperature rises again. 

Vaccination .—This procedure prevents smallpox. Every child 
should be vaccinated before it is 6 months old, and again when it 
reaches school age. If the vaccination does not take, the operation 
should be repeated until it is successful. A small papule should 
appear in 48 hours, which soon changes into a vesicle. This gradu¬ 
ally enlarges, until at the end of one week it is the size of a finger nail. 
It is then of a whitish color and is surrounded by a reddish area. At 
this time the patient may have a slight fever, headache, or some 
disturbance of digestion. On the tenth or thirteenth day these 
symptoms have usually subsided, the vesicle begins to dry up, form¬ 
ing a scab, and the redness of the surrounding area diminishes and 
finally disappears. If the vaccination is kept dry and irritating 
substances, such as woolen shirts or coats, are not allowed to touch it, 
there is little danger of harmful germs gaining entrance through the 
wound. Some physicians advise the use of celluloid shields, but these 
shields are harmful as they exclude the air and are hot and uncom¬ 
fortable. If care is taken not to break the vesicle, dressing is usually 
unnecessary; but if a dressing must be employed, the simpler the 
better. A little sterile vaseline or boracic-acid ointment, spread upon 
a piece of clean linen, generally suffices. This should extend beyond 
the inflamed area and be held in place by strips of narrow adhesive 
plaster. 


PREVENTION OF DISEASE AND CARE OF SICK. 


121 


If a person has not been vaccinated during childhood, he should 
have this operation performed immediately in order to protect him¬ 
self from smallpox. No one can tell when he might come in contact 
with this disease, and if not protected by vaccination he is extremely 
liable to contract it. After an interval of about seven years a second 
vaccination should be performed, and it should be repeated until 
successful. Smallpox has been practically eliminated from some 
countries by vaccination. 

Treatment .—The patient should be placed in a cool, well-ventilated 
room and strictly isolated; and every person who has been in contact 
with the patient should be immediately vaccinated. No one should 
be allowed to come in contact with him except the nurse or attendant 
and the nurse or attendant should not be allowed to come in contact 
w T ith other persons. 'While in immediate attendance on the sick he 
should wear overalls and jumper and a head covering, to be removed 
when he leaves the room, and immediately put on again when he 
returns. Separate dishes and necessary 
utensils should be provided. The food 
should be placed at a convenient place 
near the door of the sick room where 
the nurse can come and get it. Nothing 
should be allowed in the room except the 
articles absolutely necessary. The soiled 
clothing should be wrapped in a clean 
sheet (or in a sheet that has been dipped 
in a 1 to 1,000 solution of bichloride of 
mercury) and the bundle placed in a 
kettle of water and thoroughly boiled. 

If there is a sufficient supply of bedcloth¬ 
ing, the soiled articles should be de¬ 
stroyed by fire (burned). The patient must be kept thoroughly 
clean. Good nursing is very important. 

In the early stage, when the fever is high, place the patient in a 
cold bath, or give him a cold sponge bath, note the temperature of the 
body, and repeat the bath every three hours if the thermometer regis¬ 
ters above 103° F. (39.4° C.). If the bowels are constipated, give 
small doses of Epsom salt, 2 teaspoonfuls, every two or three hours. 

The food should be soft and nourishing and given at regular inter¬ 
vals. Cold drinks, lemonade, barley water, etc., may be freely given. 
Aspirin, 10 grains, may be given for the headache. 

The pain and tension in the skin may be relieved by cold applica¬ 
tions. A piece of lint, wet with a one-half of 1 per cent solution of 
carbolic acid, may be applied cold to the face and freajiently renewed. 
Holes should be cut into the lint corresponding to the eyes, nose, and 
mouth. When the pustules begin to form it is a good plan to touch 


Deaths from Small Pox in Countries 
WITH Compulsory Vaccination 
Laws .«««■ 

Sweden 1 

Ireland I 

Scotland 3 

Germany 3.5 

Encland < 6 . 

Deaths from SmallPox in Countries 
WITHOUT CompulsoryVaccinationLaws 


Switzerland 

Belgium 

Russia 

Austria 

Italy 

Spain 


average 

■ |M« mujom * *o«■ 


IQ.5 
16 I 
151 
510 
556 


9^3 


Fig. 91. 



122 


PREVENTION OF DISEASE AND CARE OF SICK. 


each one with tincture of iodine (a camel’s-hair brush may be used 
for the purpose), and a day later to puncture them with the point of 
a needle. The needle should first be boiled, and the point should 
then be dipped in tincture of iodine before making the puncture. 
When crusts being to form, olive oil or glycerin should be applied. 
If the hair is long it should be cut short early in the disease before 
the pustular stage begins. The eyes must be carefully cleansed 
several times a day, else blindness may follow. The mouth, throat, 
and nose also require attention. A saturated solution of boric acid 
may be used as an eyewash, a mouth wash, or a gargle (one teaspoon¬ 
ful of boric acid in a glass of water). 

When the crusts and scabs drop off they should be carefully gath¬ 
ered up and burned. The patient should then have a daily bath with 
soap and water. When the case is ended the room and all exposed 
articles must be disinfected by burning sulphur (4 pounds to every 
1,000 cubic feet of air space). 

When the case occurs on shipboard, the ship, if near port when the 
disease breaks out, should be taken direct to the quarantine station, 
where the patient may be taken care of and the ship disinfected. 

CHICKEN POX. 

Chicken pox is a disease of children, but occasionally it occurs in 
adults. The child usually becomes sick 14 or 16 days after being 
exposed to the disease. The child is restless, has a slight fever, and 
complains of itching of the skin. A papular eruption appears upon 
the face, neck, or chest within 24 hours from the time the child is 
taken sick. In a short time the papules change to vesicles. These 
have the appearance of small blisters and are due to small quantities 
of liquid accumulating under the superficial layer of the skin. At 
first the vesicles are translucent but later are opaque as their contents 
become turbid. After a day or two the vesicles rupture, crusts are 
formed, which drop off in from 5 to 20 days. The vesicles are usually 
few in number and are found mostly upon the upper part of the body. 
They may, however, be thicker in places and may extend over the 
whole surface. Sometimes they are found in the mouth and throat. 
The temperature falls when the rash fades, and it is usually greatest 
when the eruption appears. 

It is important that chicken pox should be distinguished from 
smallpox. It should be remembered that the former occurs princi¬ 
pally in children; that the eruption appears in the first day of the 
disease; that it only involves the upper layer of the skin and rarely 
produces pitting; that it appears in crops, some of the vesicles dry¬ 
ing up while others are beginning to form; that there is seldom 
headache or backache, and the fever is usually low. There is no 
secondary fever as occurs in smallpox when the pustules are formed. 


PREVENTION OF DISEASE AND CARE OF SICK. 


123 


The papule in smallpox is hard and shotlike and has a very different 
feeling from the soft, reddish spot of chicken pox. When the vesicle 
is ruptured with the finger it can be seen that it involves only the 
superficial layer of the skin, whereas the ruptured pustule in small¬ 
pox leaves an ulcer extending through the true skin. 

In spite of the distinctions between smallpox and chicken pox 
mentioned in the above paragraph it is often difficult to distinguish 
between a mild form of smallpox and chicken pox, and a physician 
should always be called in to see the patient if smallpox is present in 
the community. 

Prevention .—A child having this disease should not be allowed to 
go to school. If the child is an inmate of an orphan asylum or other 
children’s institution it should be quarantined while chicken pox is 
prevalent. In private houses quarantine is unnecessary unless the 
other children are delicate, and it is especially desirable that they 
should not catch the disease. The disease is contagious as long as 
any crusts are present. 

Treatment .—The child should be put to bed, and to relieve the 
itching sponged with warm water to which a small quantity of car¬ 
bolic acid (half a teaspoonful to the pint) is added. The carbolic 
acid should be added while the water is hot, and care should be taken 
that it is dissolved in the water before using the water. Carbolized 
vaseline (carbolic acid 3 grains, vaseline 1 ounce) is often efficacious 
in relieving itching. A warm bath should be given each day until 
the scabs come off. * 

MEASLES. 

Measles is an acute infectious disease which most commonly attacks 
children, but it may occur in adults. It usually spreads from per¬ 
son to person by exposure to a patient with the disease, as when 
going into the room where he is sick, riding in the same street car, 
or being in the same schoolroom. It generally makes its appear¬ 
ance from 12 to 14 days after exposure. One attack is nearly always 
a protection against a second one. 

Symptoms .—It begins like an ordinary cold. There may be an 
initial chill; the patient’s face looks flushed and sometimes slightly 
swollen about the nose and eyes and the eyes are reddened. There 
may be a tendency to sneeze, and an examination of the throat will 
disclose a reddening of the mucous membrane. The rash often ap¬ 
pears first in the throat. Some cough may be present at the onset, 
with more or less headache. Fever is present with the onset of these 
symptoms. The eruption on the skin develops on the third or fourth 
day of the fever. It may be most marked on the forehead or about 
the ears, looks like fleabites, and gradually spreads over the entire 
body. The patient has considerable cough, with expectoration. In 


124 


PREVENTION OF DISEASE AND CARE OF SICK. 


children there is some liability to a form of pneumonia called 
broncho-pneumonia, which renders the disease much more dangerous. 
It may also have the complication of diarrhea and vomiting, due to 
implication of the bowels and stomach. 

Prevention .—As soon as the case is discovered the patient should be 
put in bed and isolated in a room from which children are excluded 
and only those adults admitted who are directly concerned in the 
care of the case. 

Treatment .—It is necessary to prevent the patient from becoming 
chilled, and he should therefore not be exposed to drafts, but fresh 
air should be admitted to the room. If the weather is cold, he should 
be provided with plenty of covering. 

The treatment of an ordinary case of measles is practically nil, as 
little or no medication is required. If there is much irritation of the 
eyes, the room should be darkened and the eyes washed with a satu¬ 
rated solution of boric acid in warm water. Take a glass of warm 
water and put into it all the boric acid it will dissolve and use it as 
a wash for the eyes, keeping it covered to prevent dust or other 
impurities getting into the solution. Everything applied to the eyes 
should be scrupulously clean. 

If the skin is dusky and the eruption is not well marked, the pa¬ 
tient may be enveloped in sheets or blankets wrung from hot water, 
but care must be exercised that he does not become chilled after¬ 
wards. Only sufficient covering should be used to render the patient 
comfortable. 

If the cough is very troublesome, a tablet of Brown Mixture or a 
half teaspoonful of mixture pectoralis (expectorans) N. F. may 
be given every three hours. 

After the eruption has disappeared and the peeling of the skin has 
begun the patient should bathe daily in order that the skin may be 
freed from the scales. 

During the period of the disease the patient may be fed on broths, 
milk, soft-boiled eggs, etc. 

Disinfection is not now considered necessary after measles, as it is 
believed the disease is transmitted only by contact with a sick per¬ 
son, and experiments show that there is little danger of contracting 
the disease after the eruption appears. If it is desired to disinfect 
the room after the patient recovers, the following procedure should 
be carried out: 

The bedclothes should be boiled 20 minutes or soaked in a 3 per 
cent solution of carbolic acid or compound cresol for one hour. (See 
p. 104.) All the openings of the room should be closed, and it should 
be fumigated with formaldehyde gas made by placing formalin in a 
10-quart pail and pouring permanganate of potash onto it. One 
pint of formalin and one-half pound of potash should be employed 
for every 1,000 cubic feet of air space. The time of exposure should 


PREVENTION OF DISEASE AND CARE OF SICK. 


125 


be 12 hours, after which the doors and windows should be opened 
and the gas allowed to blow out. The room should then be thor¬ 
oughly cleaned and aired for several days. Mattress, curtains, rugs, 
and carpet should be taken out of the room after fumigation, hung 
in the sunshine, and well beaten before being used again. 

SCARLET FEVER. 

Scarlet fever is a communicable disease characterized by fever, 
sore throat, and a red rash. When the disease is mild it is called 
scarlatina or scarlet rash. The incubation period is from two to four 
days. It begins with headache, vomiting, faintness, and occasionally 
convulsions in children. The mouth and throat are deeply congested. 
There is pain on swallowing or talking. The tongue has the color 
of a ripe strawberry. The inflammation may extend from the throat 
to the ears. The glands of the neck often become swollen. The 
rash appears on the second day of the disease, and in mild cases may 
be the first symptom noticed. It occurs as a diffuse redness, which, 
upon close observation, will be found to be due to fine red papules. 
After four or five days the skin commences to shed. Sometimes it 
is cast off in large flakes. 

Complications .—Inflammation of many organs of the body may 
follow scarlet fever. There may be pneumonia, pleurisy, ulceration 
of the throat, abscesses in the neck, and inflammation of the lining 
membrane of the heart. Nephritis or inflammation of the kidneys 
frequently occurs from the second to the fourth week. In this com¬ 
plication there is diminution or suppression of urine, with puffiness 
under the eyes, swelling of the hands and ankles, or general dropsy. 
There may be convulsions, and tne case may quickly terminate fatally. 
In other cases the secretion of urine is reestablished and the person 
either recovers entirely or the disease persists in a chronic form. 
There may be pain, swelling, and redness of the joints. Careful 
watch should be kept for symptoms of inflammation of the middle 
ear. These are pain in the ear, tenderness over the bony prominence 
behind the ear, and drowsiness. The child may moan in its sleep 
and be hard to arouse. If the drum membrane breaks, the pent-up 
pus escapes from the ear opening, and if the inflammation is mild 
the symptoms then abate; otherwise an abscess forms in the bony cells 
behind the ear, which if not opened may break into the cranial cavity 
or spread downward along the deep tissues of the neck. 

Varieties .—Mild cases may not be recognized until some unusual 
occurrence, such as a swelling in the neck, the shedding of skin, the 
onset of nephritis, or illness in another child who has been in com¬ 
pany with the patient, calls attention to the fact that the child has 
had an attack of scarlet fever. The rash may be absent or present 
on only a portion of the body, The mild form may give rise to a 


126 


PREVENTION OF DISEASE AND CARE OF SICK. 


severe attack in another person. In a malignant case there may be 
high fever, delirium, coma, gangrene of the throat with a foul dis¬ 
charge from the nose and mouth, the patient dying in one or two 
days. 

Death is rare in cases that receive proper care and attention, 
although many persons succumb to the complications produced by 
scarlet fever, and it is often the starting point of chronic disease of 
the heart, ears, or kidneys, which cause death in afterlife. It is more 
fatal to children less than 6 years old. 

Prevention .—All persons suffering from scarlet fever should be 
isolated and should not be allowed to communicate with other people, 
except those attending upon them, as long as there are any discharges 
from the mouth, throat, ears, or other parts of the body. Physician^ 
attending upon scarlet fever patients should wear a gown which 
covers their clothing when going into the sick room and should thor¬ 
oughly disinfect their hands after each visit. The person caring for 
the sick child should not mingle with other persons, and all dishes 
should be scalded before being again used. 

Treatment .—Keep the room warm, with a window partly open for 
ventilation. Put the patient in bed but do not cover him up with 
too much bed clothing. If the child has convulsions, give him a hot 
bath; if the fever is high, sponge him off with cold water. If there 
is vomiting, apply a small mustard plaster over the upper part of the 
stomach and give him a cup of hot water in which has been placed a 
teaspoonful of sodium bicarbonate. If there is severe headache, 
give 10 grains of aspirin if the patient is an adult; if a child, give 
3 to 5 grains. Cold compresses should be applied to the neck. The 
mouth should be rinsed frequently with a saturated solution of boric 
acid (one teaspoonful of boric acid in a glass of water) and the throat 
kept clean by gargling with a solution composed of peroxide of 
hydrogen one part, water two parts. This solution may also be 
applied with a swab made by tying a small piece of cotton onto a 
small stick. If no peroxide of hydrogen is obtainable, a salt solu¬ 
tion made by placing a teaspoonful of salt to a pint of water may 
be employed in its place. One tablet of calomel, each one-half of 
a grain, should be given every half hour until four are taken. This 
should be followed in four or five hours by a Seidlitz powder or a 
dose of salts. If there is earache, hot compresses should be applied 
to the side of the head, and ear drops (carbolic acid 1 fluid dram, 
glycerin 7 fluid drams, mixed well together) should be placed in the 
ear. If possible, a physician should be called immediately; if the 
drum membrane is opened early the hearing of the patient may often 
be preserved. 

The patient should have a light diet with plenty of water to drink, 
especially if there is any sign of dropsy. If this develops, hot com- 


PREVENTION OF DISEASE AND CARE OF SICK. 


127 


presses should be applied to the back, and hot water (temperature 
from 110° to 120° F.) should be injected slowly into the bowels, sev¬ 
eral quarts at one time. If the excretion of urine is greatly dimin¬ 
ished, it may be necessary to put the patient into a hot pack. This 
is done by wringing out a sheet in hot water and immediately wrap¬ 
ping the patient in it and covering him with blankets. If electricity 
is available, the patient may be made to sweat by placing several 
light bulbs, connected with lamp socket, between the blankets on the 
patient’s bed and turning on the light. The patient should not be 
considered well until the skin has ceased peeling and all discharge 
of pus has ceased. He may then be allowed to mingle with other 
persons. The room and its contents should be disinfected as directed 
under “ Measles.” 

GERMAN MEASLES. 

German measles is an acute contagious disease of mild character 
that comes on from 10 to 16 days after exposure to the person who 
is suffering from it. 

Symptoms .—The temperature seldom rises over 100° F. The rash 
first occurs upon the face. It consists of pale r'ed papules, which do 
not assume any regular form or shape. There is considerable itch¬ 
ing of the skin. The rash appears on different parts of the body 
in succession, fading in one part while appearing in another. It 
lasts from two to five days and is followed by a slight peeling of 
the skin. The glands of the neck may become enlarged and there 
is frequently sore throat and a dry cough, but these symptoms are 
not apt to be severe. 

Prevention .—The child should be isolated and the same precau¬ 
tions taken against the spread of the disease as noted under scarlet 

fever. It does not spread as rapidly amongst children as measles, 
and the percentage of adults attacked is larger than in that disease. 

Treatment .—The treatment prescribed for measles is applicable to 
this disease. 

WHOOPING COUGH. 

Whooping cough is a contagious disease characterized by an in¬ 
flammation of the nose, throat, and bronchial tubes, associated with 
a peculiar spasmodic cough, ending in a long-drawn-out inspiration 
accompanied by a sound known as the “ whoop,” from which the 
disease gets its name. 

It is caused by a germ present in the discharges from the nose and 
mouth, which is disseminated through the air during the spells of 
coughing. Most cases occur before the tenth year, and one attack 
is usually protective for the rest of life. It is believed that girls 
are more liable to contract the disease than boys. 

•191 >71 °— 23 - 30 


I 


128 


PREVENTION OF DISEASE AND CARE OF SICK. 


Symptoms. —The incubation period is from 1 to 11 days. In the 
beginning the symptoms are like those of a severe cold. There is 
redness of the lining membrane of the nose and throat, profuse dis¬ 
charge from this membrane, and a hoarse, dry cough. The face is 
swollen, the eyes suffused and watery, the eyelids swollen and pink 
in color. The cough is severe and out of all proportion to the other 
physical signs. There is fever, but the temperature does not, as a 
rule, remain above normal after the first few days. After these 
symptoms have existed for 10 days or 2 weeks the cough changes in 
character. It occurs in paroxysms which consist of a number of 
short, quick coughs, followed by a long-drawn-out inhalation of air 
accompanied by the noise known as the whoop. The coughing spell 
often terminates with vomiting. 

Inflammation of the kidneys may be present, and the child gen¬ 
erally loses fat and presents a run-dovm appearance. Consumption 
not infrequently follows an attack of this disease, and great care 
should be taken to prevent a child suffering from wdiooping cough 
from coming in contact with consumptives. The exhaustion caused 
by whooping cough makes it more liable to contract consumption. 

Prevention .—As patients continue to spread infection six weeks 
after recovery, it is very difficult to control the spread of whooping 
cough. As, however, it is such a distressing disease, every effort 
should be made to keep w T ell children from associating with those 
having the disease. Children with the disease should be allowed to 
go outdoors, but should not be permitted to go to school or to 
moving-picture show’s or ride in street cars or in any public vehicle 
where thev may come in contact with other children. 

Treatment .—An outdoor life during the course of the disease 
should be encouraged, and if convenient the child should be taken to 
the seashore. Children in cities, on account of dust and the presence 
of harmful gases in the atmosphere, suffer more than children in the 
country. The child should gargle his throat several times a day 
with a solution of hydrogen peroxide (hydrogen peroxide, 1 part; 
water, 3 parts). A broad bandage placed tightly around the chest 
and stomach may make the patient feel more comfortable. 

MUMPS. 

Mumps is an acute infectious disease usually affecting children, 
but may occur in adults. It affects the partoid gland, which is 
situated just below’ the ear on each side. It is conveyed by contact 
from one patient to another; hence the patient should be isolated in 
a room, and children should not be exposed to the disease. Only the 
adults directly in charge of the case should be admitted to the room 
unless they have been protected by a previous attack. An attack 
usually comes on about 15 days after the exposure to the disease. 


PREVENTION OF DISEASE AND CARE OF SICK. 


129 


Symptoms .—The chief symptoms are pain and swelling in the 
parotid region under the ear. Movements of the jaw, such as chew¬ 
ing and talking, will be painful. Swelling may occur on one or both 
sides, but nearly always both are involved. It is worst about the 
third day, and may gradually disappear after that. It is usually a 
mild disease, but swelling of the testicle is a frequent complication in 
the male. 

Treatment .—Light diet, such as broths, eggs, milk, rice puddings, 
etc., should be given. Sour food and acid drinks will be found to 
give considerable pain if taken in the mouth; hence they should be 
avoided. Hot applications may be placed over the swollen glands 
if there is very much pain. No internal medicines are indicated. If 
the bowels are constipated, a tablespoonful of Epsom salt may be 
administered with benefit. 

CONSUMPTION (TUBERCULOSIS). 

Consumption, or, as it is often called, tuberculosis, is due to the 
tubercle bacillus, a small organism which attacks various parts of 
the body. The infection may be general or it may be localized to a 
particular portion of the body, such as the lungs, the intestines, the 
bones, the glands, the nervous tissue. The only form that will be 
considered in this book is consumption (tuberculosis) of the lungs. 

Symptoms .—The first noticeable symptom of tuberculosis of the 
lungs may be a hemorrhage, the blood being coughed up, but the 
onset is usually gradual. The patient has a slight cough, feels weak, 
and indisposed to do anything, loses weight, and has very little 
appetite. If the temperature is taken in the evening, it will often be 
found that he has a slight fever. In a few weeks or months the 
emaciation becomes more marked, the fever is higher, there are 
sweats at night, severe cough, shortness of breath, and a large amount 
of mucopurulent matter is expectorated. There may be severe dia- 
rhea from extension of the disease to the bowel, or the larynx may be 
involved, causing the voice to be husky and swallowing extremely 
painful. The patient’s sleep is disturbed by the coughing spells, 
which are violent and protracted. As the disease progresses the 
symptoms increase in severity and the patient is confined to his bed 
until death brings him relief from his suffering. 

Prevention .—Many physicians believe that consumption is con¬ 
tracted only during childhood and that a large number of persons 
become infected with the organism and recover. This belief is 
strengthened by the fact that healed lesions of tuberculosis are often 
found in persons who have died of other diseases. The presence of 
tuberculosis in adults is explained by the theory that the germs of 
this disease gain a foothold in the body in childhood, but do not 
cause disease until later in life. Tubercle bacilli which enter the 


130 


PREVENTION OF DISEASE AND CARE OF SICK. 


system during childhood may be encapsulated and become active at 
any time that the resistance of the body is lowered by deficient 
nourishment, overwork, or some other exhausting condition. It can 
thus be readily seen that it is extremely important that children 
should not mingle with adult consumptives. This is especially the 
case as children, not being usually cleanly in their habits, are apt to 
get dust and dirt containing tubercle bacilli on their hands and 
become infected through their habit of putting their fingers in their 


HOW [HE GERMS OF CONSUMPTION ARE CARRIED FROM THE SICK TO THE WELL. 



Consumptive spitting on 
floor. Flies feeding on it. 
carry the germs of the 
disease to food. 


The spit dries and care¬ 
less sweeping, dusting or 
draughts cause the germs 
to float in the air 


The germsmay enter the 
bodies of children play¬ 
ing on the floor, through 
seres or wounds. 



Others may get the disease by breathing 
or swallowing the' germs. 

Spray given off in sneezing or coughing, 
contains germs in a moist and active state. 



Putting food, money, pencils, etc., 
into the mouth after a consumptive 
has poisoned them with his spit. 


Fig. 100. 

(New York State Department of Health.) 


mouths. Another danger from which children should be protected 
is ingestion of tubercle bacilli in milk obtained from diseased cows. 
For this reason it is important that all cattle should be tested to 
ascertain if they have tuberculosis in order that no milk from such 
cows should be used. In addition it is best to pasteurize milk, as 
this process will kill tubercle bacilli if any are present in the milk. 
For a description of the process, see page 190. 

Tuberculosis is also liable to develop in children recovering from 
measles, whooping cough, pneumonia, scarlet fever, and other acute 


























Fig. 93.—(By courtesy of the Metropolitan Magazine.) 



Fig. 94.—(By courtesy of the Metropolitan Magazine.) 





















Fig. 95.—Consumption. Air cell of the lung with 
the first accumulation of tubercle bacilli. 




Fig. 97.—Comsumption. Cheesy destruction 
of a pulmonary air cell. 



Fig. 96.—Consumption. Pulmonary air 
cell with inflammation from tubercle 
bacilli. 



Fig. 98.—School girl with adenoids. 



Fig. 99.—An exceptionally dangerous tuberculous cow. Directly after 
this cow was removed from a dairy herd, because she reacted with 
tuberculin and not because she showed symptoms of tuberculosis, a 
small nodule about the size of a pea was discovered under the skin of 
her udder. Examination of the milk from the quarter of the udder 
in which the nodule was located revealed the presence of numerous 
virulent tubercle bacilli. The cow was permitted to live some time, 
because it was desirable to use her infected milk for special investiga¬ 
tions. 









































PREVENTION OF DISEASE AND CARE OF SICK. 


131 


diseases. Children who have suffered from them should be kept out 
in the open air, given plenty of food, and should not be required 

have recovered their strength. Children 
ha\ ing adenoids or diseased tonsils should have the same removed, 
as the obstruction to breathing caused by these structures encourages 
the development of tuberculosis. If the disease attacks the intestinal 
canal, the bones, or the glands of the neck the children so attacked 
should receive careful treatment by a physician or surgeon in order 
that they may be cured. 

There is little danger of a person suffering from consumption in¬ 
fecting adults in the same house if he will take the proper precau- 


A CAREFUL CONSUMPTIVE—NOT DANGEROUS TO LIVE WITH. 




Fig. 101. 

(New York State Department of Health.) 


tions. The danger lies in the sputum, which, after drying, is inhaled 
by others in the form of dust. To prevent this a consumptive should 
never spit upon the floor or ground. The sputum should be caught 
on tissue paper, which should be placed after use in a paper bag. 
This bag and its contents should be burned in a few hours before 
the sputum has had time to dry. If the sputum is profuse, a cup 
with a cover may be employed, but this cup should be boiled for half 
an hour several times each day. It is well also to keep the cup 
partially filled with a 3 per cent carbolic acid or compound cresol 
solution. 

Handkerchiefs or pieces of cloth should not be used for wiping the 
mouth or nose unless they are boiled immediately afterwards. Sheets 































132 


PREVENTION OF DISEASE AND CARE OF SICK. 


and pillowcases that may be soiled during the night' by the sputum 
should be boiled the first thing in the morning. Towels used by the 
patient should be boiled immediately thereafter. The patient should 
have separate dishes and these should be sterilized by boiling after 
each meal. He should keep his face clean shaved, and he should kiss 
no one. nor should he under any circumstances sleep in the same bed 
or the same room with other persons. After death the room should 
be disinfected as described under “ Measles.” 

Treatment .—A person who has tuberculosis should be under care 
of a skillful physician. No exercise should be taken except by the 
doctor's order. At night he should sleep and by day he should rest 


IN CASE OF CONSUMPTION, LOOK TO THESE FOR CURE. 




GOOD FOOD REST 

Fig. 102. 

(New York State Department of Health.) 


on a porch, balcony, or lean-to, where he will be in the open air. 
Many persons who conscientiously follow this treatment recover. 

There is no medicine that will cure consumption and medicine 
should only be used to alleviate symptoms in the latter stage of the 
disease. A medicine containing an opiate such as mistura pectoralis 
(expectorans), N. F., is sometimes necessary in hopeless cases to con¬ 
trol the cough and allow the patient to get a little sleep. Sleeping 
in the open air will often prevent the cough and make it unnecessary 
to give a cough mixture. If night sweats are severe, a little atropin 
sulphate, one or two tablets, each ^ grain, given during the after¬ 
noon and at bedtime will often prevent them. The patient should 
be kept in bed day and night if he has fever, and he should not be 
allowed to get up and walk around until several weeks after all 
fever has subsided. The diet should be nutritious and generous, 







Fig. 103.—A good method of building a porch on the back of a cottage for country use. 
Loaned by the Journal of the Outdoor Life.—Carrington. 



Fig. 104.—A cheap porch protected by awnings, built on the roof of a first-story veranda, 

Carrington. 





























Fig. 105.—Parasites of tertian malaria. 
(After Thayer and Hewetson.) 



Fig. 106.—Parasites of estivo-autumnal ma¬ 
laria. (After Thayer and Hewetson.) 


■■ ■■ 

HI sit 




• 

{ »•-; ' 

. f -j , ■ 

/. __ __ ----- 


Fig. 107.—Parasites of quartan malaria. 
(After Thayer and Hewetson.) 



Fig. 108.—Fertilized female malarial 
parasite (Zygote). (After Craig.) 



Fig. 109.—Stomach of mosquito with oocysts. 
(After Craig.) 



Fig. 110.—Sporozoites in oocyst. 
(After Craig.) 



Fig. 111.—Sporozoites, 
(After Craig.) 






















PREVENTION OF DISEASE AND CARE OF SICK. 


133 


and such articles as milk, eggs, fish, and fowl, together with an 
abundance of fat, should be eaten. A mixture of raw eggs and milk 
stirred together is recommended. Eight or twelve eggs and the 
same number of glasses of milk may often be taken daily in this way. 

MALARIAL FEVER. 

Malarial fever is caused by minute organisms, which, upon being 
introduced into the blood stream, attack and destroy large numbers 
of red corpuscles. After entering a corpuscle the organism increases 
in size until it occupies nearly the whole of the disk, when it sepa¬ 
rates into a number of segments, each of which when set free may 
attack another corpuscle, and the process is repeated. The period 
of time which elapses from the entrance of the germ into the cor¬ 
puscle to the breaking down of the same and the extrusion of the 
young parasites varies from 24 to 72 hours, depending upon the 
variety of the parasite which is present. The chill of malarial fever 
corresponds to the disintegration of the corpuscles and the release of 
the new forms. A poison is also 
liberated at this time, and the 
action of this poison upon the 
system accounts to a great ex¬ 
tent for the chill. 

After malarial organisms 
have existed in the blood for 
a considerable time, ovoid and 
crescent shapes begin to appear. 

These forms are quiescent and 
are not known to undergo fur¬ 
ther development in the human body. When, however, during the 
process of biting, they are drawn up into a mosquito’s stomach 
through its bill, other changes take place, which finally result in a 
number of other organisms (sporozoites) finding themselves in the 
salivary glands of the mosquito. If this mosquito now bites a person, 
a portion of the secretion of this gland containing these organisms 
is injected into the wound caused by its bite, and the person thus 
becomes inoculated with the malarial organism and contracts the 
disease. This will not occur, however, until a sufficient time has 
elapsed to allow the new forms to develop and find their way into the 
saliva of the mosquito. This usually takes from 10 to 14 days from 
the time the mosquito bites the person infected with malaria. 

Malaria is carried only by certain kinds of anopheles mosquitoes. 
The female alone is capable of transmitting disease; it is doubtful 
if the male bites at all. Anopheles mosquitoes are distinguished by 
their palpi, which are nearly as long as their bill, The wings are 



Fig. 112.—Germs of malaria were sent 
from Italy to England in a mosquito, 
and a physician who was bitten by the 
mosquito developed malaria. (Ritchie’s 
“Primer of Sanitation.”) 




134 PREVENTION OF DISEASE AND CARE OF SICK. 

spotted or have a dusky hue. When the insect rests upon a flat 
surface it extends its body in a straight line instead of humping 
itself up like other kinds of mosquitoes. The male is known by its 
antennae, which are large and covered with fine hairs, giving them 
the appearance of plumes. (See fig. 51.) 

Symptoms .—There are two varieties of malarial fever—intermit¬ 
tent and estivo-autumnal malarial fever. The tertian form is the 
most common of the intermittent variety. The parasite in this form 
is known as the Plasmodium vivax. The time occupied by this or¬ 
ganism in developing in the blood corpuscle is 48 hours, the new 
parasites being released at the end of that period. 

The chill, therefore, occurs every other day. In some cases there 
is a double infection with this same organism and a chill occurs 
every day. This is called the quotidian type. In another type, 
known as the quartan, the chill occurs every fourth day, and is due 
to a parasite called the Plasmodium malaria ?. 

A malarial chill consists of three stages—the cold, the hot, and the 
sweating stage. The attack may be sudden or it may be preceded 
by a feeling of uneasiness, a desire to stretch the limbs and yawn, 
headache, loss of appetite, and sometimes vomiting. The chill may 
be of any degree of severity. Patients sometimes complain only 
of chilliness or of a creeping sensation of coldness over the back. 
More frequently the chill is well marked; the feeling of cold spreads 
all over the body, the teeth chatter, the patient shivers, and his whole 
body shakes. This cold stage may last from a few minutes to an 
hour or longer. The hot stage gradually comes on as the cold stage 
subsides, and soon there is a feeling of intense heat. The face be¬ 
comes flushed, the pulse full or bounding, the headache continues, 
and the patient is in a high fever. This stage may last from half 
an hour to four or five hours, when perspiration appears, first on the 
forehead and gradually over the entire body, and the sweating 
stage is fully established. With the appearance of perspiration the 
fever declines, the distressing symptoms gradually cease, the patient 
experiences a feeling of great relief, and soon falls into a refreshing 
sleep. The duration of the sweating stage varies from one to three 
hours. 

The perspiration may be slight or very profuse. At the end of 
the sweating stage the patient may be greatly prostrated or may 
feel quite well and able to be up and about until the beginning of 
the cold stage of the next fit, 24, 48, or 72 hours from the beginning 
of the first. 

Estivo-autumnal malarial fever is due to the Plasmodium falci¬ 
parum. This variety of malarial fever is more apt to run an irregular 
course than intermittent malarial fever. The paroxysm, consisting of 
chill, fever, and sweat, may be longer and the fever may be con- 



Fig. 113.—^4 is the Anopheles mosquito (the mosquito that 
carries malaria), showing its position while resting, and 
the spots on its wings. B shows the common mosquito 
(Culex). 





: 





SCMZOCONV (Asexual Gtntiyilienj 

in M*x. 


1 

$ 


* ”5 6 * 



SPOROCONY (Stomal GfnmUsn) 

\'M\ B/ in tks Mosquito 


Maxryamctr(f) ® .V (8|.V .- y V’; 

l© >| 


® ? 



I© 






Oeeyst with SjwwUnxts. 


Oociftl 


f *»/* 

vcrmu'ttU. 




Fig. 114.—Diagram illustrating the human and mosquito 
cycles of existence of the malaria parasite. (From Mar¬ 
tin’s General Pathology.) 



Fig. 115.—Malaria. The tertian parasite. 















Fig. 116.—Chronic malaria causes great 
enlargement of the spleen. 



Fig. 117.—View showing arm against mosquito bar so that 
mosquitoes have access to individual. 



Fig. 118 .—Tucking in the mosquito bar, 



















PREVENTION OF DISEASE AND CARE OF SICK. 


135 


tinuous or only drop in the morning hours. Some cases closely re¬ 
semble typhoid fever, consumption, abscess of the liver, or abscess of 
other parts of the body. Such cases are difficult to distinguish from 
these diseases. If this variety of malarial fever is neglected or 
improperly treated, pernicious symptoms may prove threatening and 
serious. 

There are several types of the pernicious form of estivo-autumnal 
malarial fever: The cerebral type in which there is intense head¬ 
ache, high fever, wild or perhaps muttering delirium, rapidly passing 
into unconsciousness, and death may occur w T ithin a few hours of 
the beginning of the attack; the algid type in which there is severe 
vomiting and purging, stools are numerous, watery, and large, pulse 
weak and rapid, body cold and face blue and pinched; the pneumonic 
type in which there is congestion and a pouring out of fluid into the 
bronchial tubes which if not relieved will cause death. 

Hemorrhages from different parts of the body, but especially from 
the nose, mouth, gums, stomach, or intestines, may occur in any form 
of estivo-autumnal malarial fever. When there is blood in the urine, 
the latter has a dark color and is known as “blackwater disease.” 
At one time it was thought that “blackwater disease” was caused 
by the quinine administered for the cure of malaria, but those physi¬ 
cians who have had most experience now agree that this is not true, 
and many cases occurring in the employees along the Panama Canal 
Zone have been cured by quinine. 

Chronic malaria is due to improper treatment. No thoroughly 
treated case of malaria becomes chronic. Wherever a chronic case is 
found it is evidence of neglect of treatment or of insufficient protec¬ 
tion from the bites of malarial mosquitoes. In this condition the 
patient is pale, jaundice may be present, and the body swollen from 
dropsy, the liver and spleen enlarged, the latter causing the so-called 
“ ague cake,” which can be felt in the left side of the abdomen. 

Prevention .—Every possible means should be employed to get rid 
of anopheles mosquitoes. The grass and weeds around the house or 
likely breeding places should be kept short in order that they can 
obtain no shelter from the wind and hot sun. The former blows 
them away, and if exposed to the rays of the latter they die. Pools 
and marshes in which they breed should be filled in or drained, or, 
if this is impracticable, oiled, as described on page 56. Collections 
of water around the house, if not disposed of at once, should be 
screened or oiled. As the malarial mosquito bites mostly at night, 
it is important that the house should be thoroughly screened. The 
method of doing this is shown on page 18. Persons should not go 
out of the house in the evening if it can be avoided. Mosquito bars 
should be used if the house is not screened, but they afford less 
protection than good screening, A mosquito bar should not have a 


136 PREVENTION OF DISEASE AND CARE OF SICK. 

slit up the side, nor should it go over the head and foot boards of 
the bed. It should hang from the ceiling and be tucked in all around 
the mattress. If allowed to touch the floor, mosquitoes may crawl 
under it or a breeze may blow it up and allow mosquitoes to get 
under it. The bed should be sufficiently large for a person to lie in 
without coming in contact with the mosquito bar, as otherwise a mos¬ 
quito may bite the person through the netting. 

Persons having malarial parasites in their blood should be pro¬ 
tected from mosquitoes, for if a mosquito should bite a person so 
infected some of the organisms may be sucked up into its stomach 
and, after undergoing the changes related above, be injected into the 
body of a well person with which the mosquito might come in con¬ 
tact. It is important, therefore, that everyone having malarial para¬ 
sites in his blood should be under the care of a physician and should 
receive treatment until all of these parasites have disappeared. It 
has been shown that in temperate regions malarial organisms are 
carried over from one season to another in the blood of people who 
have been suffering from the disease, and it is these so-called “ car¬ 
riers ” who spread the disease from one community to another and 
who keep it alive during the cold weather. It has been found that 

mosquitoes caught early in the spring do not 
contain malarial organisms, but that these 
forms are developed in their bodies after the 
mosquitoes have had an opportunity to bite 
persons whose blood is infected with the 
organisms. 

Healthy persons can guard against con¬ 
tracting malaria by taking quinine. Six 
grains every day will be enough, although some physicians 
administer 10 grains twice a week, the second dose to be taken 
the day after the first, or 15 grains every eighth and ninth day. 
The taking of quinine is a procedure of vital importance for the pro¬ 
tection of persons from malaria in tropical countries and in the 
Temperate Zones, where malarial mosquitoes abound. 

Treatment .—When a chill occurs, the patient should at once be 
wrapped in blankets and be given hot drinks. Hot-water bottles, 
heated bricks or stones wrapped in cloth or in a separate piece of 
blanket, should be placed at the feet. Mustard plasters may also be 
applied to the extremities and over the region of the heart. 

During the hot stage cold drinks may be administered; if it is 
severe, a tepid bath in a tub or by means of a sponge may be given. 
If the temperature is very high, 105° or 106° F., a cold bath should 
be given. (See p. 90.) 

As soon as the sweating stage begins 10 or 15 grains of quinine 
should be taken, and along with this, if the bowels are not freely 


Cases of malarial fever 
per 1000 men per year. 

BEFORE QUININE, 27S 
SINCE QUININE, 4? 

Fig. 121. 


PREVENTION OF DISEASE AND CARE OF SICK. 


137 


open, a calomel tablet, one-tenth grain each, should be given every 
15 minutes until 10 have been taken. Every six hours thereafter 
the patient should take 5 grains of quinine for two or three days 
and then 5 grains three times daily for the next tw T o weeks. 

If vomiting occurs, a mustard plaster may be placed over the region 
of the stomach, above the navel, and cracked ice may be given by 
the mouth. Headache may be relieved by cold applications or by 
10 grains of aspirin taken with a cup of hot tea. 

In pernicious types of malarial fever the treatment should be 
more active. No time should be lost in giving the quinine; 20 
grains should be given immediately, with 2 grains of calomel. A 
physician should be summoned if the services of one can be ob¬ 
tained, as dilute solutions of quinine may have to be injected into 
the patient's veins in order to save his life. 

YELLOW FEVER. 

The mosquito which conveys yellow fever from one person to an¬ 
other is a striped black and white mosquito, ^cles calopus , and 
therefore the disease only occurs where this mosquito abounds. 
Moreover, the mosquito must have been previously infected by biting 
a person ill with the disease during the first few days of his illness. 
An interval of about 12 days or more after this bite appears to be 
necessary before the mosquito is capable of communicating the dis¬ 
ease to a person. 

Symptoms .—The onset in yellow fever is sudden. It frequently 
comes on at night or in the early morning. The patient is taken 
with a chill, headache, a pain in the back, and fever. The pulse is 
rapid at first, but afterwards falls, even though the temperature re¬ 
mains high. The eyes are injected, the skin has a slight flush, and 
the upper lip is often swollen. Albumen is often present in the 
urine as early as the second day. The test for albumen has been 
described on page 170. Jaundice appears early, and is especially 
noticeable as a yellowness of the eyes. The stomach is irritable 
and the bowels constipated. The fever lasts for two or three days 
and is succeeded by a period of calm. In mild cases the fever does 
not return, but in others the temperature again rises after a few 
hours and severe symptoms set in. The pulse is slow and weak, 
the jaundice deepens, and the vomiting increases. The vomited 
matter may consist of altered blood of a coffee-ground color, whence 
the name black vomit which has been given to this condition. The 
urine is scanty and albuminous and may be entirely suppressed. 
The strength rapidly fails, and the patient dies from exhaustion. 

Diagnosis .—It is often difficult to tell yellow fever from malarial 
fever and dengue. Great care should be taken to determine as far as 
49G71 23-11+12 



138 


PREVENTION OF DISEASE AND CARE OF SICK. 


possible the disease from which the patient is suffering, as the 
treatment is different in each case and a. mistake may be followed by 
serious results. 

The yellow fever chill usually occurs in the night or early morn¬ 
ing; the chill of malarial fever may take place at any time during 
the day. The yellow fever chill is much less severe than the malarial 
chill. Jaundice come on early in yellow fever and is of a much 
lighter color than in malarial fever. If the malarial fever is of 
the intermittent variety, there will only be fever for a few hours and 
the patient will feel comparatively well until the next paroxysm takes 
place. It is often difficult for the layman with the facilities available 
to distinguish between these two diseases. 

Yellow fever and dengue are similar, but the pains in the latter dis¬ 
ease are much more severe. There is seldom jaundice or albumen 
in the urine in dengue and the skin eruption helps to distinguish 
between the diseases. 

Prevention .—The patient should be immediately isolated in a 
screened room, as it is important that no mosquito should be allowed 
to bite him during the first few days of his illness, as one of them may 
become infected with yellow fever and other members of the family 
may subsequently be given the disease by being bitten by it. If the 
patient dies during the first three or four days of his illness, the room 
should be immediately fumigated with sulphur (see p. 65) for two 
hours in order to kill any mosquitoes that have come into the room 
and become infected. If the patient is alive after this period he 
should be carefully moved out of the room for a few hours, the room 
fumigated, and then the patient returned to it. Great care should be 
taken, however, in moving the patient, as the least exertion may be 
followed by a fatal result. He should be kept flat on his back and 
not allowed to sit up. 

A vessel arriving at a port where there is yellow fever should, if 
possible, anchor at a point that is too far away for the mosquitoes to 
fly on board, and it should be so placed that they will not be blown 
aboard by the prevailing winds. It should be remembered that mos¬ 
quitoes may be brought to the vessel by bumboats on fruits and 
vegetables or on the coats of persons in such boats. These boats 
should, therefore, be warned off and told to keep away. If boats 
have to come alongside, their contents and occupants should first be 
freed from mosquitoes. As the yellow fever mosquito bites in the 
day time as well as night, shore leave should not be granted to the 
crew in yellow fever ports. If the vessel has to go to the dock or if 
it is impossible to keep mosquitoes off it, the living quarters should 
be screened and measures described on page 64 should be taken to 
prevent their breeding on board. A person on board who has fever 


PREVENTION OF DISEASE AND CARE OF SICK. 


139 


or feels ill should immediately be placed in a screened room until it is 
ascertained that he is not suffering from yellow fever. 

The yellow fever mosquito is a domestic mosquito and breeds in 
small collections of water, in old tin cans, buckets, barrels, cisterns,* 
and other containers around dwellings. It is therefore important 
that such breeding places should either be eliminated or screened. 
The methods for the eradication of mosquitoes are described on 
page 56. 

Treatment .—As soon as the attack of yellow fever begins, place the 
patient at rest in bed on a blanket, and immediately give him a hot 
footbath. The foot tub shuld be half full of warm water, to which 
a pound of mustard may be added. The patient’s feet and legs are 
then placed in the water, and a quantity of hot water is added, so as 
to make the bath as hot as he can stand it. While it is being- given 
the entire body of the patient should be covered with blankets, and 
he should drink hot tea. After the footbath is removed, the patient 
should be allowed to perspire for 10 minutes. His body must then be 
quickly dried and wrapped in a fresh blanket. A 5-grain dose of 
calomel should then be given, which may be followed in six hours by 
a tablespoonful of Rochelle salt in a glass of water, or in place of 
the calomel two compound cathartic pills may be given. If vomiting 
occur, a large mustard plaster should be placed over the region of 
the stomach and small pieces of ice in the patient’s mouth. 

The diet in yellow fever is very important. For the first day or 
two very little if any food should be given. A little milk diluted 
with vichy water may be allowed every three hours. Later a little 
broth and very gradually, when the fever is reduced, other light and 
easily digestible articles may be allowed in small quantities at regular 
intervals. 

If the fever is high and the patient is restless, 10 grains of aspirin 
may afford relief, and, if necessary, a second dose may be given after 
an interval of three hours. Vichy or other alkaline mineral water 
should be given in small quantities frequently repeated. The bowels 
should then be kept open by means of rectal injections of warm, 
soapy water. A long tube attached to the syringe should be passed 
into the bowels as far as possible and at least a quart injected once or 
twice a dav. 

BREAK-BONE FEVER (DENGUE). 

This disease occurs during the summer and autumn in the southern 
part of the United States and throughout the year in tropical coun¬ 
tries. It is believed that it is conveyed by mosquitoes, especially 
those belonging to the species Ovlex fatiga/ns. 

Symptoms .—It begins with a slight chill, accompanied by fever 
and severe pains in the bones, muscles, and joints. There is a red 


140 


PREVENTION OF DISEASE AND CARE OF SICK. 


flush on the skin. These symptoms last for two or three days and the 
temperature then goes down and the patient has a profuse sweat. 
The patient feels sore, but greatly relieved. After several days 
. another paroxysm occurs, but the second is much milder than the 
first. The eruption that appears upon the skin varies in intensity 
and character, but it often resembles measles, begins on the hands 
and legs and extends thence to the body. The disease leaves the 
patient in a weak condition, and convalescence is protracted. 

Prevention .—Prevention consists in protecting oneself as far as 
possible from the bites of mosquitoes. (See p. 56.) 

Treatment .—Ten grains of aspirin may be given to the patient 
and repeated if necessary. Morphine (one-fourth of a grain) may be 
required if the pains are severe. The patient should be kept in bed 
while the fever lasts and be given a generous diet of milk, soup, eggs, 
and gruels. During convalescence plenty of meat, bread, vegetables, 
and fruit should be eaten to enable the patient to regain his strength. 

SPOTTED FEVER (CEREBRO SPINAL MENINGITIS). 

This disease is caused by a germ which produces inflammation of 
the membranes covering the brain and spinal cord. It is thought to 
be communicated principally through carriers, that is, persons who 
are not ill or only slightly so but who have germs of the disease in 
their nose and throat. The disease prevails principally among 
children and young adults, especially in cold climates during the 
winter and spring, and is more likely to attack those living in ill 
ventilated, overcrowded houses. Some epidemics have occurred 
exclusively in villages. 

Symj)toms .—The disease begins with a convulsion or a chill, fol¬ 
lowed by pains in the muscles, severe headache, fever, rapid pulse, 
and increased respiration. Vomiting is nearly always associated 
with these symptoms. Delirium usually appears early. The muscles 
may be contracted so that the legs can not be extended, the neck is 
stiff, and the back rigid. The pains are often so severe that the 
patient cries out. This is especially the case if he is disturbed by a 
noise, if the bed is jarred, or if an attempt is made to turn him or 
move him. The eruption from which the disease takes its name, 
“ spotted fever,” consists of small, round purplish spots either scat¬ 
tered over the whole body or limited to certain areas. It is caused 
by hemorrhages under the skin and is not always present. 

Prevention .—Persons suffering from this disease should be iso¬ 
lated. The nose and throat of the patient and of all persons who 
come in contact with him should be sprayed with a chlorazene solu¬ 
tion (18 grains of chlorazene to 1 pint of water) or a menthol 
solution (menthol, 5 grains; liquor petrolatum, 1 ounce). If the 


PREVENTION OF DISEASE AND CARE OF SICK. 


141 


disease is prevalent, it is well for all persons to use this spray, as they 
may be carriers and convey the disease to others, especially to 
children and young adults. The bowel discharges, urine, and sputum 
should be disinfected with a solution of bleaching powder made by 
adding 1 pound of bleaching powder to 4 gallons of water. Equal 
parts of the solution and the substance that is to be disinfected 
should be used. The mixture should be allowed to stand at least 
one-half hour before emptying. The person caring for the patient 
should not be permitted to mingle with other people and should be 
careful to wash his hands with the bleaching-powder solution or 
with a bichloride solution, 1 to 2,000 (see p. 104), whenever he handles 
the patient. All toAvels, sheets, and other clothes used about the 
patient should be boiled or disinfected with the bleaching-powder 
solution. * 

Treatment .—The patient should be kept in a darkened room, as 
far as possible away from noise. Aspirin (10 grains) should be 
given as required to relieve pain. For very severe pain, morphine 
may be required. If morphine is combined with hyoscine, a smaller 
amount is required; the dose of each in this case would be morphine, 
one-eighth of a grain; hyoscine, one two-lmndredths of a grain. It is 
important to obtain the services of a physician early, if it is possible 
to do so, in order that a lumbar puncture may be made with a hollow 
needle, the excess fluid drawn off, and a curative serum injected. The 
earlier the serum is used the more likely will it prove beneficial. 

CHOLERA (EPIDEMIC CHOLERA, ASIATIC CHOLERA). 

Cholera is an infectious disease caused by a specific organism dis¬ 
covered in 1884 by Koch, of Berlin, Germany, and named Comma 
bacillus, because its shape as seen under the microscope is not unlike 
that of a comma. 

Cholera is not endemic in any part of the word except Asia. Its 
home is in India, where in certain localities it has been endemic 
probably for centuries. 

Every epidemic of cholera is probably due to a spread of the dis¬ 
ease, directly or indirectly from its home in India. It is apt to be 
developed in the wake of moving masses of human beings. It fol¬ 
lows the great lines of travel to different parts of the world. It is 
spread through the agency of the dejections from cholera patients, 
which contain the comma bacilli. The disease may also be trans¬ 
mitted by persons known as carriers who have the comma bacilli in 
their intestines but are not sick with the disease. This is one of the 
chief means by which the disease is spread, as these carriers may 
have the bacilli of cholera in their stools for many weeks and thus 
convey the disease to many persons with whom they come in contact. 


142 


PREVENTION OF DISEASE AND CARE OF SICK. 


The comma bacilli find their way into the water supply or become 
attached to different articles of food and are then in turn introduced 
through the mouth into the bodies of healthy persons. They may 
be conveyed in soiled clothing or in merchandise of different kinds. 
A ship with infection on board may carry the disease from one end 
of the world to the other. 

An attack of cholera may be of any degree of severity. The symp¬ 
toms usually begin after a period of incubation of from two to five 
days. The mildest forms are called choleriac diarrhea. The stools 
are watery, rather large, and of yellowish color, and, in the absence 
of other symptoms of true cholera, may be mistaken for ordinary 
diarrhea; or the attack may begin with colicky pains, purging, and 
vomiting, as in cholera morbus. 

All such symptoms occurring in persons who have been ashore at 
infected ports or who have drunk water taken at such ports should 
be regarded as extremely suspicious. Under ordinary circumstances 
it is difficult to distinguish between severe cases of cholera morbus 
and genuine cholera. Cholera morbus is usually due to indigestible 
food or other irritating exciting cause, and, while true cholera is not 
due to such a cause, persons with weak or irritable stomachs are more 
apt to be attacked by cholera than are healthy persons. 

Cholera begins with looseness of the bowels or an apparently 
simple diarrhea. After a day or two or within an hour or two the 
diarrhea may become very violent. The evacuations soon lose their 
yellowish color and assume the gravish-white appearance known as 
“ rice-water stools.” Severe cramps occur in the feet and calves of 
the legs, and sometimes in the hands and arms. Vomiting soon 
follows. There is a burning sensation in the stomach and the thirst 
is unquenchable. The urine is suppressed. Large quantities of fluid 
may gush from the mouth as well as from the rectum; the patient 
sinks into a condition of collapse. The skin is cold and covered with 
a clammy sweat. The tongue is coated and cold to the touch, the 
voice is faint and husky, the breath icv. The whole bodv shrinks. 
The temperature in the mouth may fall from 5° to 10° below normal, 
while in the rectum it may rise several decrees above normal. The 

c 1 

intellect usually remains clear until near the end. 

In the serious forms of cholera the patient falls into collapse and 
dies within an hour from the beginning of the attack. 

In the milder forms, or if the patient survives the collapse of the 
severe forms, the symptoms gradually subside, the skin becomes 
warm, the pulse stronger, urine is again passed, the stools become 
more natural, and the patient recovers. But there may be a relapse 
or a low type of fever, called cholera-typhoid, may develop and prove 
fatal within a few days. 


PREVENTION OF DISEASE AND CARE OF SICK. 


143 


Prevention .—During the prevalence of an epidemic of cholera or 
while in the vicinity of ports on the Indian coast where the disease 
is epidemic, every case of mild diarrhea, looseness of the bowels, 
or irritable stomach should receive most careful attention, for the 
reason that, as already stated, cholera often begins with such symp¬ 
toms, and if the infection is brought on board, the men with bowel 
or stomach trouble of any kind are usually the first victims of the 
dread disease. No fruits or raw vegetables should be eaten. The 
drinking water must be boiled. The patient should be carefully 
isolated and everything brought into contact with him or contami¬ 
nated by his excretions must be disinfected. The person who waits 
on the patient should be careful to wash his hands in a solution of 
bichloride of mercury, 1 to 2,000, whenever they become soiled or 
before eating his meals. The hands should never be carried to the 
mouth unless they have been disinfected. It is well for the nurse 
to wear rubber gloves if they can be obtained. The stools should 
be passed into a chamber containing a solution of carbolic acid, com¬ 
pound cresol, or bleaching powder. (See p. 104.) The linen and bed¬ 
clothes should be disinfected by one of these solutions or by dry heat, 
steam (212° F.), or boiling. The spoons, knives, plates, and utensils 
of any kind should be boiled immediately after they are used. Flies 
must be kept out of the compartment. 

A ship with cholera on board should go to the nearest quarantine 
station, not only for treatment of the sick, but also for examination 
of the well, and above all for the disinfection of the ship, so as to 
prevent further spread of the disease. 

Treatment .—In the first stages of true cholera the treatment is 
about the same as for cholera morbus, already described. Opium 
(laudanum), morphine are the remedies chiefly to be relied upon. 
The patient should be encouraged to drink large quantities of water, 
to each quart of which has been added 1 teaspoonful of bicarbonate 
of soda. Hot coffee and tea are valuable in the stage of collapse. 
They may be injected into the rectum if the patient can not retain 
them in the stomach. Warm water containing 1 teaspoonful of salt 
and 1 teaspoonful of carbonate of soda to the quart, should be 
injected into the rectum through a long soft-rubber tube or large 
catheter attached to a Davidson or, preferably, a fountain syringe. 
One or two quarts may be introduced slowly. The patient should be 
wrapped in warm blankets and have hot-water bags, hot bottles, or 
hot bricks placed to his extremities and alongside his body (care¬ 
ful. of course, not to have them too hot lest great harm be done by 
burning the skin). 


144 


PREVENTION OF DISEASE AND CARE OF SICK. 


THE PLAGUE. 

Plague, one of the most dangerous of all infectious diseases, is 
caused by a specific microorganism (the bacillus pestis) discovered 
in 1894 bv Kitasato, a Japan physician. 

The disease is commonly called bubonic plague for the reason that 
in the large majority of cases buboes (inflamed and enlarged lym¬ 
phatic glands) form in the groins. But there is another and more 
fatal form of the disease, known as septicemic plague, in which 
buboes are not apparent. Cases of this form run such a rapid course 
that the patient dies of septicemia (blood poisoning) before the 
buboes appear. 

There is also a dangerous and fatal form of the disease recognized 
as pneumonia plague. This form begins like pneumonia ; the sputum 
is bloody and contains multitudes of the bacilli. 

Buboes occur in about 75 per cent of all cases, chiefly in the groin, 
but also in the armpit and neck and occasionally about the elbow and 
the knee joint. They are usually developed by the third or fourth 
day, sometimes within the first 24 hours; occasionally as late as the 
second week. They vary in size from a marble to a goose egg, and as 
a rule are very painful. Sometimes, after attaining a considerable 
size, the buboes are absorbed; more frequently they suppurate and 
break. Small boils or abscesses may form on different parts of the 
body. In some cases dark-colored spots (petechia) from slight 
hemorrhages form in or beneath the skin. Hemorrhages may also 
occur from the nose or mouth or from any mucous membrane. 

The bacilli are found in the buboes, blood, and internal organs. 
They enter the body through the respiratory tract, or by way of 
abrasions or small injuries of the skin. Rats are the chief carriers 
of the disease from house to house or from dock to ship. The in¬ 
fection is spread from rat to man by fleas. (See p. 58.) Most 
epidemics of human plague are preceded by wholesale deaths among 
rats. When the disease attacks the lungs of man it is communicable 
to others by sneezing and coughing. 

Symptoms .—The incubation period of plague varies from 2 to 12 
days. Occasionally the onset of the disease is preceded by prodromal 
symptoms lasting from 12 to 36 hours, characterized by chilliness, 
headache, nausea, congestion of the eyes, nosebleed, giddiness, an 
anxious and painful expression of the face, mental depression, and 
sometimes dull pain in the groin and armpits. In most cases, how¬ 
ever, bubonic plague begins suddenly with fever, which may or 
may not be preceded by a chill. The temperature rises rapidly and 
reaches its highest point, 105° or 106° F. (40.5° to 41.1° C.) on 
the second or third day. The pulse, at first full, rapidly becomes 
small and weak, and the beats vary from 100 to 150 or more per 



Fig. 119.—-Side view showing mosquito bar prop¬ 
erly tucked in. 


Fig. 120.—End view showing mosquito 
bar properly hung and tucked in. 



Fig. 122.—Cholera bacilli, mucous flake 
preparation. 




















Fig. 124.— A lG-year-old victim of hookworm disease. Fig. 125.—The same girl after treatment for hookworm. 











PREVENTION OF DISEASE AND CARE OF SICK. 


145 


minute. The tongue, at first moist and red or white coated, soon 
becomes dry and brown, and dark-colored crusts (sordes) may form 
on the teeth, lips, and nostrils. Delirium or coma is apt to set in. 
Prostration is extreme, and the patient may die in this early stage 
before the bubo attains any considerable size, or, as in the septicemic 
form of the disease, without the appearance of the bubo at all. 

In some cases on the third or fourth day the temperature drops a 
degree or two, but generally rises again until about the fifth or sixth 
day, when it suddenly drops to normal or subnormal. Death may 
or may not take place in this stage. More frequently there is a sud¬ 
den rise in the temperature immediately preceding death, and in 
favorable cases the temperature falls to the normal gradually. 

About TO per cent of all cases die within the first six days. Sur¬ 
vival of the sixth day may therefore be regarded as a hopeful sign. 
In cases which tend to recovery the synnptoms improve gradually. 
Convalescense is slow, and at the seat of the bubo an indolent sore 
may be left, which is very slow to heal. 

Prevention .—The patient should be immediately isolated in a clean 
and well-ventilated compartment, and all parts of the house or ship 
should be thoroughly fumigated with sulphur to kill rats and fleas. 
(See p. 65.) The discharges from the patient—urine, feces, vomit, 
or sputum—should be passed into bowls or pots containing a solu¬ 
tion of carbolic acid, compound cresol, or bleaching povrder. (See 
p. 104.) 

The person detailed to wait on the patient should be free from 
sores or scratches of any kind, and should exercise the most scrupu¬ 
lous care of his hands, and all articles brought into contact with the 
patient should be disinfected. (See p. 104.) In pneumonic plague 
the nurse should wear a mask to protect himself from inhaling the 
plague bacillus when the patient coughs or sneezes. 

A ship with plague on board should be taken to the nearest quaran¬ 
tine for necessary treatment, and to give the survivors the best chance 
for life. 

Treatment .—Constipation should be relieved by calomel, 5 grains, 
followed in five hours by a dose of Rochelle or Epsom salt. The food 
should be concentrated and nourishing. If diarrhea is persistent, it 
may be relieved by salol in 5-grain doses, given every three hours. 

Ice or cold water should be applied to the aching head and the hot 
body sponged with cold or tepid water. In the earlier stage of the 
buboes the local application of ice is useful. Later on, if softened, 
they should be incised and dressed with iodoform gauze. Pain and 
restlessness may be relieved by morphine, one-sixth grain, repeated 
in two hours if necessary. 


146 


PREVENTION OF DISEASE AISD CARE OF SICK. 


BERIBERI (THE KAKKE OF JAPAN). 

Beriberi is a form of multiple-neuritis (inflammation of nerves), 
characterized by numbness, tenderness, and edema (dropsical swell¬ 
ing) of the legs and other parts of the body; by irritability of the 
heart, extreme weakness, and paralysis. It is a disease which occurs 
mostly in tropical climates, but is frequently carried by ships into 
temperate latitudes. A warm climate, however, is not necessary to 
develop the disease, as a number of years ago it was present among 
Gloucester fishermen. A diet of polished rice may produce the 
disease. (See p. 75.) Cases are often found where a one-sided diet 
is supplied. Four forms of the disease are recognized: 

(1) The mild or rudimentary form begins with a feeling of weak¬ 
ness and numbness of the extremities, with edema of the skin and 
tenderness of the muscles, especially of the calves, uneasiness in the 
belly, shortness of breath, and palpitation of the heart. These symp¬ 
toms may last only a few days or several weeks and then disappear, 
but recurrences are common. 

(2) In the dry or atrophic form there is no edema, but the other 
symptoms are marked and more rapidly develop. Instead of edema 
and puffiness there is atrophy of the parts. The tendon reflexes are 
lost. The muscles of the legs and arms and sometimes of the face 
are paralyzed and painful. All the muscles of the body waste away. 
The patient presents a pitiful, shrunken appearance, suffers intense 
pain, is sensitive to the slightest touch, and may die from general 
exhaustion or, after lingering many months, gradually improve and 
get well. 

(3) The wet or dropsical form begins with symptoms similar to 
those of the mild form, but the edema soon extends over the entire 
body, watery effusions into the serous sacs take place; there is marked 
shortness of breath, frequently nausea and vomiting, and always 
weakness of the heart. Death may occur from heart failure or from 
paralysis of respiration. On the other hand, the dropsy may grad¬ 
ually or rapidly disappear and leave the patient in essentially the 
same condition as that described under the head of the dry or atrophic 
form. 

(4) The most serious or dangerous form of beriberi is called the 
acute pernicious cardiac form. In this the general symptoms of the 
disease may be only slightly developed, but the cardiac (heart) 
symptoms are marked. The disease in this form usually lasts sev¬ 
eral days or weeks, but death may occur from heart failure within 
24 hours from the onset. 

Prevention and treatment .—The diet should be immediately 
changed. Wheat flour and oatmeal should be substituted for rice. 
Fresh meat and vegetables should be supplied if they can be obtained; 


PREVENTION OF DISEASE AND CARE OF SICK. 


147 


onions, dried beans, and peas should be eaten; potatoes should be 
cooked in their jackets: as few canned goods as possible should be 
taken. When a vessel is being fitted out for a long voyage care should 
be exercised to provide food which contains ingredients necessary to 
health. A man who is ill with the disease should be relieved of duty 
and kept in bed. as there is danger of heart failure if he is permitted 
to exert himself in any way. 


SCURVY. 1 

Scurvy is a disease produced by improper or unsuitable food. 
Many years ago it was of frequent occurrence among seafaring men 
on long voyages. Now it is a comparatively rare disease, thanks to 
better provisions and better methods in issuing food supplies. 

Symptoms. —Swelling, sponginess, and bleeding of the gums. The 
teeth become loose and frequently drop out. The breath is foul, the 
tongue swollen. The skin becomes dry and scaly. Hemorrhages 
(small dark red spots) occur under the skin, first on the legs and then 
on the arms and other parts of the body. Bleeding from the nose 
frequently occurs. Swelling about the ankles is common. The skin 
of the legs is frequently discolored in large blotches, and there is 
often a peculiar hardness or induration of the muscles of the calf of 
the leg. The complexion is frequently of greenish or dirty-yellow 
hue. The pulse is rapid and weak. There may or may not be slight 
fever. The bowels may be constipated or there may be a troublesome 
diarrhea. 

In severe cases debility and emaciation are quite marked. The 
mind wanders, and occasionallv there is wild delirium. 

Prevention and treatment .—This consists almost wholly in a change 
of diet. Give fresh vegetables, fresh milk, fresh beef, oranges, lemons, 
limes, or lime juice. Begin with small quantities at short intervals, 
and increase the allowance as rapidly as the stomach can take care of 
it. Pickles, onions, sauerkraut, raw potatoes, and raw cabbage are 
valuable articles in the make-up of a varied diet. 

Potassium chlorate dissolved in water should be used as a mouth 
wash, and the gums should be frequently painted with tincture of 
myrrh. The skin should be kept in good condition by frequent 
bathing. The sleeping quarters should be clean and well ventilated. 

TAPEWORMS. 

A tapeworm consists of a head, neck, and a ribbon-like trunk 
made up of segments. As it grows new segments are formed while 
the hindmost segments, containing the eggs, are thrown off. If the 
cast-off segments are eaten by animals the eggs develop into embryos 


1 See Appendix B, Note 


p. 314. 







148 


PREVENTION OF DISEASE AND CARE OF SICK. 


which bore through the intestinal wall of the animal, enter the blood 
stream and become lodged in its tissues. Here each embryo is sur¬ 
rounded by a capsule, and if the meat of the animal is eaten by a 
human being the capsule is digested and the worm is set free. It 
attaches itself to the intestinal wall and it again begins to develop 
into an adult worm. 

Beef tapeworm (Toenia saginata ).—This is the commonest of the 
large tapeworms and occurs in man after eating raw or uncooked 
beef containing the embryo. Beef tongues are especially liable to be 
infected. The head of the worm is small and hardly visible to the 
naked eye. Under the microscope the head is seen to have four 
suckers by which it attaches itself to the intestinal wall. This worm 
sometimes reaches a length of 30 feet, and is often one-third of an 
inch broad as its thickest part. The segments vary from 18 to 30 in 
number. 

Pork tapeworm (T oerda soliwn ).—This tapeworm is not as com¬ 
mon as the beef tapeworm. It develops in the small intestines after 
eating raw or underdone “ measly ” pork, and ranges from 6 to 13 
feet in length. The head, besides 4 suckers, has a circle of 26 long 
and short hooks by which the worm holds on to the lining membrane 
of the bowel. 

Symptoms .—Tapeworms may develop in man at any time of life. 
They do not cause symptoms until about three montns after the in¬ 
fected meat has been swallowed. It is a popular idea that tapeworms 
cause many symptoms, but the disturbances caused by the worms are 
limited to the abdomen. The infected persons usually have voracious 
appetites, and they are liable to attacks of constipation alternating 
with diarrhea, pains in the abdomen, indigestion, nausea, and vomit¬ 
ing. The presence of a tapeworm is known by the passage of the seg¬ 
ments, which m ly be seen in the stools, or found in the bed or clothes 
of the patient. 

Prevention .—Care should be taken not to eat undercooked beef or 
pork. Cattle and hogs should not be allowed to drink water which 
has been contaminated with discharges from privies or water-closets, 
as this water may contain tapeworm eggs from the human body. 
Animals who drink this water may become infected, and the tape¬ 
worm may then be transmitted to persons who eat the meat of these 
animals. For this reason a tapeworm that has been discharged by a 
person should be burned and should not be thrown out where it can 
be eaten by animals. 

Treatment .—Treatment consists first in starving the tapeworm, 
and then dislodging it by medicines which make it let go its hold 
upon the lining membrane of the intestine. The patient should not 
eat anything except a light diet of milk and soup for two days prior 


PREVENTION OF DISEASE AND CARE OF SICK. 


149 


to taking the medicine and nothing should be eaten the evening of the 
day before the drug is taken. There should be no breakfast in the 
morning, and the medicine should be taken about 10 o’clock. Vari¬ 
ous curative substances are used, the best probably being a fresh 
preparation of the extract of male fern. The dose for an adult is one- 
half to 1 dram. It should be given in capsules and should be fol¬ 
lowed in a few hours by a dose of salts. If there is pain and the 
bowels do not move easily, an injection of warm water is adminis¬ 
tered. Instead of male fern, a decoction of pomegranate bark may 
be used. This is made by adding 4 ounces of pomegranate bark to a 
quart of water. This mixture should be allowed to stand for 24 
hours and then boiled until it is reduced to 5 ounces. The whole 
amount of the pomegranate bark should be taken in three or four 
doses at short intervals. Pumpkin seed mashed up and made into a 
paste with sugar is also a useful remedy. The seeds should be de¬ 
prived of their envelopes. About 4 tablespoonfuls should be taken. 

ROUNDWORMS. 

Roundworm (Ascaris lumbricoides). 

This worm is of a yellowish or reddish brown color and measures 
from 7 to 14 inches in length. It is about the diameter of a goose 
quill. There may be only a single worm or several may inhabit the 
intestines. The eggs gain entrance into the human body through 
drinking water and food. 

Symptoms .—They may not cause any symptoms and their presence 
may only become known when they are passed in the bowels. They 
may, however, give rise to pain in the abdomen, and cause diarrhea 
and loss of appetite. Occasionally a worm will pass up into the 
stomach, w T here it w 7 ill cause nausea and vomiting, or will enter the 
bile duct, and produce jaundice. If the worms are present in large 
numbers, the bow T els may be obstructed, with accompanying serious 
symptoms. 

Prevention .—All w’Orms should be burned immediately after they 
are passed from the body so that their eggs can not get into water 
used for drinking purposes. The fact that these worms may infect 
the human body through drinking water should be remembered so 
that care may be taken to obtain only waiter from the purest sources 
or that which has been passed through a purifying plant. 

Treatment .—A light diet should be taken while medicine is being 
administered. Santonin is efficient, given in doses of one-fourth 
to 1 grain to a child and 2 to 4 grains to an adult. This dose should 
be given tw T ice a day for several days and should be followed by a 
purgative, such as 1 or 2 grains of calomel. 


150 


PREVENTION OF DISEASE AND CARE OF SICK. 


Seatworm (Oxyuris vermicularis). 

This is a small worm of a whitish color, being from one-sixth to 
one-half inch long. It is found mostly in the lower portion of the 
bowel where it causes intense itching when it crawls out through the 
opening. 

aS ymptoms .—The itching is worse at night. The skin may become 
inflamed and reddened through scratching to relieve the itching and 
considerable pain of a burning or bearing down character may be 
present. The condition may seriously interfere with sleep. Inspec¬ 
tion of the stools will show the presence of the Avhite threadlike 
parasites. 

Prevention .—Persons become infected by swallowing eggs that 
may be present in drinking water or upon uncooked food and fruit 
that has come in contact with the hands of infected persons. The 
eggs may be embedded under the nails of ignorant and unclean per¬ 
sons who may infect themselves and other persons. 

Treatment .—A purgative should be taken to drive the parasite into 
the lower bowel, and after this acts an injection consisting of a de¬ 
coction of quassia bark should be given into the rectum. This de¬ 
coction is made by boiling 1 or 2 Ounces of the bark in a pint of water. 
The underclothes should be changed and boiled and the person’s 
skin should be washed with a solution of carbolic acid prepared by 
dissolving half a teaspoonful of carbolic acid in a pint of boiling 
water. 

Hookworm (Nercator americanus). 

Hookworm disease is due to small, round worms which attach 
themselves to the lining membrane of the intestine, suck the blood, 
and cause the condition of anemia and emaciation which are such 
marked features of the complaint. The disease is due to a poison 
produced by the worm. 

The life history of the worm is described by Stiles as follows: 

Life History. —The adult hookworms live in the small intestine, occasionally 
in the stomach. They mate in the bowels, and the females deposit numerous 
eggs. The eggs do not, however, undergo full development until they are dis¬ 
charged with the fecal material from the host. Thus every individual hook¬ 
worm found in the intestine represents infection with a separate germ. 

Free Life. —After a short time (eight hours to several days), the period 
varying according to conditions of heat and moisture, a tiny embryo develops 
in each egg. This embryo breaks through the eggshell and feeds on the ground 
or in the night soil. In the course of two days or so the embryo sheds its skin, 
but continues to feed. After about a week the worm sheds its skin again, but 
continues to live inside of its discarded skin, and it no longer takes any food. 
During this development, the rapidity of which may vary according to circum¬ 
stances, the worm undergoes a growth in addition to certain changes in 
structure. The worm which lives in its second cast-off skin represents the 



Fiu. 127.—Figure of u worm about 7 days old. This is tho so-called “encysted stage" and is the stage which enters man. (Original.) 











Fig. 128.—Chancre of lip. Bank: clerk; possibly 
received from dirty bills. 


Fig. 129.—Chancre of upper lip. Pos¬ 
sibly received from common drinking 
cup. 




Fig. 130.—Chancre, lower lip. Inoculation 
by kissing. 


Fig. 131.—Chancre of cheek. Inoculation 
by barbel-. 













PREVENTION OF DISEASE AND CARE OF SICK. 


151 


Infecting stage which enters man and is sometimes called the “ encysted stage.” 
It may live in this condition for five months, perhaps longer. 

Mode of Infection. —Infection may occur in two different ways, namely, per 
mouth or per skin. 

Mouth infection .—Formerly infection by mouth was supposed to be the only 
method by which the worms entered the human body. Then when the method 
of skin infection became known opinion went to another extreme, and there was 
a tendency to ignore or minimize the mouth infection. Opinion is now moving 
back again in the other direction, and indications are accumulating to support 
the view that infection by mouth is by no means rare or exceptional. 

Skin infection .—If in the infecting stage it gets upon the skin, either of per¬ 
sons who go barefooted or who handle infected dirt, the worm bores its way into 
the pores, as into hair follicles, and escapes from its surrounding sheathlike 
skin. It then starts on its passage through the body. It may enter the blood, 
pass through the heart, filter out in the lungs, crawl up the trachea, down the 
esophagus, through the stomach, and find its way to the small intestine. In 
laboratory experiments on animals the worms may be found in the intestine 8 
to 14 days (possibly earlier) after the skin infection has been practiced. Arriv¬ 
ing in the intestine, the worm sheds its skin two more times, becomes adult and 
mates, and Looss has proved in the case of the Old World hookworm that eggs 
may be found in the stools 71 days after infection. 

Claude Smith found eggs in the feces six and one-lialf weeks and seven weeks 
after experimental skin infection on two persons with the American parasite. 

Symptoms .—While the worms are working their way through the 
skin, an intense itching is produced, which is called “ ground itch.” 
Small vesicles occur at the point of entrance, the skin becomes red¬ 
dened and is usually covered with scratch marks, due to the patient’s 
effort to relieve the itching. This is the first stage of the disease. 
Later, when the worms reach the intestinal tract, the patient becomes 
pale and thin. Children are undersized, with large bellies; they are 
stupid and backward in their lessons at school. Their appetite is 
perverted, patients often eating clay, plaster, cotton, and other indi¬ 
gestible substances; there is pain and tenderness in the abdomen: 
constipation is common; stools are clay colored and may be streaked 
with blood. The afflicted person tires easily and gets out of breath 
from slight exertion. Dizziness and headache are not unusual 
symptoms. 

Prevention .—Hookworm disease is a disease of rural communities. 
It is prevented by providing a safe means for the disposal of human 
excreta. (See p. 39.) The habit of going barefoot in warm climates 
greatly increases the liability of contracting infection. The treat¬ 
ment consists mainly of the administration of thymol, but this should 
only be taken under the direction of a physician. 

SYPHILIS. 

Syphilis is a constitutional disease, caused by a microorganism 
called Spiroehcrtce pallida. It is communicable and is usually ac¬ 
quired during sexual contact. It may, however, be contracted in 
many different ways, direct and indirect. It begins by a primary 


152 


PREVENTION OF DISEASE AND CARE OF SICK. 


lesion or sore, called a chancre, at the seat of inoculation (where the 
virus enters), and is followed by eruptions of the skin of different 
forms and different degrees of severity and variable duration. Sores 
also appear at the angle of the mouth and mucous patches develop on 
the lips, tongue, inner sides of the cheeks, and sore throat is often 
present. Mucous patches or syphilitic warts are also frequently seen 
about the anus or in any region where the skin is moist. The hair 
frequently falls out, the eyes are sometimes seriously involved, and 
sooner or later every organ in the body may become affected. 

The primary or initial lesion of syphilis (the hard chancre) usually 
appears about 3 weeks after exposure, but may be as early as 10 or 
12 days or as late as 5 or 6 weeks. It begins as a red spot or papule, 
which usually breaks and forms a small ulcer with hard edges. 
Sometimes the sore appears as a simple excoriation or superficial 
ulcer without hard edges. The neighboring glands become in the 
course of a week or two enlarged and hard. They seldom suppurate. 
About two months later the skin eruption and other secondary symp¬ 
toms begin. The lymph glands above the elbow, along the side and 
back of neck, and all over the body are usually enlarged. Patient 
frequently complains of headache and pain in the limbs, always worse 
at night, and may have slight, occasionally considerable, fever. 

Prevention .—A man suffering from syphilis in an active form 
should be compelled to use separate drinking cups, knives, spoons, 
forks, towels, etc. These articles should be disinfected by boiling 
or by one of the solutions described on page 104. He should under 
no circumstances smoke the pipe belonging to another man or allow 
another man to smoke his. He should sleep in a separate bed and 
all his belongings should be kept strictly to himself, for unless the 
greatest care is taken other persons may contract the disease from 
him. Chancre of the lip may be acquired by smoking the pipe of a 
syphilitic. No one suffering from syphilis should kiss or fondle 
another person, as he is liable to convey the disease to that person. 

Treatment .—For the primary sore bathe the part with soap and 
water and dust boric acid over it twice a day. 

If secondary symptoms, eruptions of skin, etc., appear, give a pill 
of protiodide of mercury, one-sixth grain, three times a day. Sal- 
varsan, diarsonal, or some other similar arsenical preparation is the 
best remedy for the disease, but this medicine can only be given by 
a physician. The mouth and teeth should be kept clean by means 
of a soft toothbrush and Castile soap and water, or water to which 
a small quantity of bicarbonate of soda (baking soda) or tincture of 
myrrh has been added. If mucous patches appear in the mouth, 
smoking must not be allowed. After dressing a syphilitic sore, a 
person should wash his hands carefully with soap and water and 
then in a disinfecting solution. (See p. 185.) 


PREVENTION OF DISEASE AND CARE OF SICK. 


153 


SOFT CHANCRE (CHANCROID). 

Soft chancre or chancroid is a virulent ulcer. It usually begins 
within 36 hours after exposure, first as a red spot, but rapidly de¬ 
velops into an ulcer covered with thick yellowish pus. The period 
of development is about three or four days. Sometimes a week 
elapses from the time of exposure to the development of the sore, 
and occasionally the period of incubation is as long as 10 days. A 
sore appearing within a few days or a week or even as late as 10 
days after exposure is usually regarded as a chancroid; but in 
practice this is not a safe rule, for the reason that many venereal 
sores are of a mixed character. The inoculations of both poisons 
may take place at the one and the same spot—the result is a mixed 
chancre; or if two sores appear, the origin of one may be syphilitic, 
the other chancroidal. It is therefore difficult, if not impossible, in 
many cases to determine the character of the disease from the period 
of incubation or from the appearance or local characteristics of the 
sore. A mixed chancre is a syphilitic chancre (a hard chancre), 
while its appearance may be precisely like that of the soft chancre 
or chancroid. The only safe plan is to regard all venereal sores as 
suspicious until a microscopical examination can be made to deter¬ 
mine if the /Spirochcetce pallida , the organism of syphilis, is present. 
The mixed chancre, as already stated, is essentially a syphilitic 
chancre, and the beginning of constitutional disease. Its local effects, 
however, may be precisely the same as those of soft chancre or chan¬ 
croid. The ulcer or ulcers (sometimes there are two or more) may 
remain as small as a pea or grow as large as a quarter, and if it be¬ 
comes phagedenic (eating) may spread over a large surface of the 
body. It is also proper to state that a secondary syphilitic sore may 
appear under the foreskin, as well as at any other place on the body, 
and that cancer (epithelioma) of the organ may begin as a small 
ulcer. The latter, however, is a rare disease as compared with the 
different varieties of chancre. 

The most frequent complications of soft chancre or chancroid is 
inflammation of the lymph glands of the groin (bubo), known to 
the sailor as “blue balls.” Another troublesome and serious com¬ 
plication is the elongation and contraction of the orifice of the fore¬ 
skin (phimosis), on the inner surface of which the sores may be 
located. The swelling and tension may be so great as to produce 
gangrene (mortification). If the foreskin is very tight and pulled 
back and cap not be brought forward again, the condition is known 
as paraphimosis, which produces great swelling, the same as if a 
string were tied around the organ, frequently resulting in severe 
ulceration and destruction of tissue. This condition may also be 


154 


PREVENTION OF DISEASE AND CARE OF SICK. 


the result if the inflammation and swelling are marked and the 
foreskin very tight. 

Treatment .—The sore should be dried and covered with a small 
piece of aseptic gauze or absorbent cotton, and later a dusting powder 
of boric acid may be applied. 

If phimosis exists, the cavity of the foreskin should be syringed 
out with hot water, and if there are sores under the foreskin which 
can not be reached by the boric acid the cavity should be syringed 
with a solution of one-half teaspoonful of carbolic acid to one-half 
pint of hot water. Soft chancres or chancroids appearing at the anus 
or rectum should be treated by frequent washings of warm water and 
the application of calomel. 

In all cases, wherever the sore is located, cleanliness must be in¬ 
sisted upon, and, as already stated, in nearly all inflammations of 
whatever character hot water alone is a valuable remedy, and rest 
in bed is of equal importance. If a lump (bubo) appears in the groin, 
rest in bed is of the greatest importance. The diet should be light 
but nourishing. Tincture of iodine, pure, or diluted one-half with 
alcohol, may be painted over the lump, but it is not of much value. 
Rest is the important thing. If the bubo goes on to suppuration, it 
should be carefully opened with the point of a sterilized knife (see 
p. 176) and kept open by a strand of aseptic gauze, which must be 
frequently changed, and enough aseptic gauze should be placed on 
top of the wound to absorb the discharges. The soiled gauze should 
be burned, and the person handling it must be careful to wash his 
hands in soap and water and in a disinfecting solution. (See p. 217.) 
The patient's bowels should be moved once a day. 

GONORRHEA (CLAP). 

Gonorrhea is a specific inflammation of the urethra due to a micro¬ 
organism called gonococcus. It usually begins during the first week 
after exposure, sometimes as early as 3 or 4 days, and occasionally 
as late as 10 days or 2 weeks. The first symptoms are a tickling or 
itching sensation and a slight swelling about the lips of the orifice 
of the urethra. A purulent creamv-colored discharge soon appears, 
and a burning or stinging pain attends the passage of urine. The 
inflammation gradually extends to the deeper parts of the urethra, 
and, unless checked by medication, reaches its height about the end 
of the second or during the third week. The patient may experience 
great difficulty in passing water. If the inflammation runs very high, 
abscesses may form in the tissues around the urethra, and swelled 
testicle and bubo are frequent complications, also painful erections 
and bending of the organ (chordee). Phimosis or paraphimosis 
occurs if the foreskin is tight or becomes involved in the inflamma¬ 
tion. 


PREVENTION OF DISEASE AND CARE OF SICK. 


155 


If phimosis occurs, and if the cavity of the foreskin is not thor¬ 
oughly and frequently washed out, “ venereal warts ” are apt to form. 

True gonorrhea, if carefully treated, gradually subsides and recov¬ 
ery may take place in from four weeks to two months. A urethral 
discharge that recovers in a few days or a week is probably a simple 
urethritis. 

Gonorrhea is urethritis (inflammation of the urethra), but ure¬ 
thritis is not necessarily gonorrhea. 

Prevention .—This disease is not as serious an affection for men as 
for women. In man it may in time cause a stricture of the urethra, 
which, if neglected, may be followed by retention of urine and dis¬ 
ease of the kidneys, or sterility may result if both of the spermatic 
ducts become permanently closed. These sequelae are, however, rare, 
and men usually get well without permanent injury, but it often takes 
a long time to cure them. The acute symptoms generally subside 
within a few weeks, but a slight discharge may be present for months 
or years. This discharge may be noticed only occasionally, as after 
drinking beer or severe muscular exertion. No man should ever 
marry as long as this discharge is present and until he is pronounced 
cured after a careful examination by a competent physician, as he 
may convey the disease to his wife. 

Gonorrhea in women is a very serious complaint, as the gonococcus 
is liable to travel up into the womb and extend from there to the 
ovaries and peritoneum (the serous membrane lining the abdominal 
cavity). It often produces a severe inflammation of these structures, 
resulting in the formation of abscesses and adhesions which bind the 
organs together in one mass. This causes sterility and invalidism, 
due to constant suffering. Most of the operations performed on the 
reproductive organs of women are for the relief of conditions follow¬ 
ing gonorrhea. 

Treatment .—Rest in bed, light diet, plenty of water to drink, 
regularity in eating and sleeping. Keep the bowels open by taking a 
moderate dose of Epsom salt in the morning. Avoid strong coffee 
and tea, all stimulants, and greasy articles of food. Keep the body 
and mind at rest. Bathe frequently in hot water. Be very careful 
not to carry any of the pus from the urethra to the eyes. (Gonor¬ 
rheal inflammation of the eyes is a serious disease, which not in¬ 
frequently results in total blindness.) 

Injections of silvol 5 parts, water 90 parts; argyrol, 10 per cent 
solution; permanganate of potash 1 part, water 5,000 parts; or sul¬ 
phate of zinc 1 grain, water 1 ounce, into the urinary canal may ba 
used. They should be employed as follows: The patient first passes 
his water, the urinary canal is then washed out with several syringes 
full of warm water. One of the above solutions is then injected 
slowly into the canal and held there five minutes by the watch. The 


156 


PREVENTION OF DISEASE AND CARE OF SICK. 


best syringe for this purpose is one made of glass, having a plunger 
wrapped with cotton thread. If a. testicle swells, apply cloths wrung 
out of cold water, or an ice bag. Bub the affected part w T ith the fol¬ 
lowing mixture: Oil of wintergreen (10 drops) and olive oil (1 
teaspoonful). The treatment of bubo is described on page 142. If 
ehordee is troublesome, apply cloths wrung out of cold water. 

STRICTURE OF THE URETHRA. 

True or organic stricture of the urethra is a narrowing of the tube. 
It is commonly the result of long-continued or neglected gonorrhea. 
Stricture of the urethra may be produced by direct injuries, as kicks 
or falls on the perineum, or by the use of too strong injections, or by 
the careless passage of instruments. 

Occasionally stricture results from simple urethritis, not gonor¬ 
rheal, and symptoms not unlike those of stricture are sometimes 
caused by a stone in the bladder obstructing the ]:>assage, and by an 
enlarged prostate gland. 

Gonorrheal stricture of the urethra is usually of slow development. 
It may be several months or years after the attack of gonorrhea 
before the patient becomes conscious of any change in the size or 
shape of the stream. First there may be only a twisting or flattening 
of the stream. In severe cases it gradually becomes smaller and 
smaller, until it is no larger than a knitting needle and passed with 
great difficulty, or it comes away drop by drop, and finally results in 
complete retention. One of the earliest symptoms of stricture is 
a gleety discharge from the urethra. 

Occasionally retention of the urine is the first symptom of the 
disease. 

Sudden retention may be due to spasm of the urethra (spasmodic 
stricture). 

Spasmodic stricture may occur independently of any specific dis¬ 
ease of the urethra, but it is more frequently a complication of 
organic stricture. Exposure to cold and wet (catching cold), or a 
debauch, are the usual exciting causes. 

When retention occurs the bladder gradually becomes distended 
and a fullness or distinct tumor may be felt in the lower part of the 
abdomen, which in severe cases may extend as high as the navel. 
Sometimes there is an involuntary flow, or an overflow of urine from 
a distended bladder—a patient says he can not hold his water, and in 
such case it may be difficult to convince him that he is suffering from 
retention until a catheter is passed and a quantity of urine is with¬ 
drawn. 

Treatment .—A neglected stricture of the urethra is a serious dis¬ 
ease, the treatment of which is difficult in many cases, even in the 
hands of the most experienced surgeon. 


PREVENTION OF DISEASE AND CARE OF SICK. 


157 


If a case is allowed to run on until there is an actual stoppage or 
retention of urine, the consequences are extremely serious, and death 
may result unless this condition is relieved. 

Place the patient on his back with his knees slightly drawn up, 
and try to pass a catheter. The instrument should first be thoroughly 
cleansed by placing it in boiling water. It should then be oiled with 
olive oil, and carefully passed into the urinary passage and an effort 
made with the greatest gentleness to pass it into the bladder. Try 
the largest size catheter first; if this fails, try the smaller ones. If 
a catheter can not be passed at the first trial, place the patient in 
a hot bath, give him 20 drops of laudanum or one-quarter grain mor- 
phic sulphate, and an hour or two later try the catheter again. If it 
is not practicable to place the patient in a full bath of hot water, then 
cover his belly and other parts of his body with flannels wrung out of 
hot water and change them every 15 minutes. The object of the hot 
bath and the laudanum is to produce relaxation. Sometimes a pa¬ 
tient will pass his water in the bath. 

COUGHS AND COLDS. 

When a person has a cough that lasts more than two or three 
weeks, even though the symptoms are mild, the case is serious enough 
to require an examination by a physician, and one should be con¬ 
sulted on the first opportunity. 

A case of bronchitis or bad cold usually begins with a cough, some¬ 
times starting with an irritation in the throat, which gradually 
travels down into the lungs. Though the cough at first is dry, there 
will be some expectoration later on, especially marked in the morning 
on first arising. It may at first be white and tenacious, later on 
becoming yellowish. With this there will be some soreness over the 
upper and front part of the chest, and if the cough is violent there 
will be considerable soreness of the muscles between the ribs. 

Treatment .—For the soreness over the chest a good rubbing with 
soap liniment may help to relieve the symptom. A tablet of Brown 
Mixture or one teaspoonful of Mistura pectoralis (expectorans) N. F. 
given every three hours is serviceable. The bowels should be kept 
open by a tablespoonful of Epsom salt, when necessary. 

Patients with coughs and colds should not be kept in a hot, dry 
room without ventilation. Plenty of fresh air should be allowed to 
come into the room, with the precaution, however, that the patient 
be not exposed to a draft and that he be properly clothed so as not 
to become chilled when the weather is cold. 

A cold in the head may often be aborted if the patient, when he 
feels the cold coming on, will take a hot bath or a hot mustard foot 


158 PREVENTION OF DISEASE AND CARE OF SICK. 

bath, go to bed, drink hot lemonade or hot weak tea, and cover him¬ 
self up well until a good perspiration is induced. Care should be 
taken next day to wrap up carefully if he goes out of the house, as 
otherwise the symptoms may return in greater severity. Aspirin in 
doses of 5 to 10 grains every three hours may be taken during a 
cold if there is headache or pain in the limbs. Menthol drops are 
useful (p. 310). 

CROUP. 

Croup alone is never fatal, though alarming to anxious parents. 
It is important not to mistake a slow developing “ croupy ” cough 
of diphtheria for croup, which develops rapidly. 

Prevention .—Diseased tonsils and adenoids should receive atten¬ 
tion. Local applications of ice water or a cold compress will often 
prevent attacks. A mild mustard plaster applied to the throat 
and chest may act in the same way. If a child is especially sub¬ 
ject to this condition, it is sometimes best to use steam from the 
so-called u croup kettle.” This is arranged by covering the top of 
the bed with sheets, which should be raised some distance above the 
child's head. The steam from the kettle, heated by alcohol, is then 
conveyed into this space. The steam keeps the air moist and pre¬ 
vents the spasm. Care should be taken the next day to see that the 
child does not go out of doors and is not exposed to drafts, in order 
that he may be prevented from catching more cold. 

Symptoms .—The attack is preceded by hoarseness and a loud, 
rough cough, which, from its peculiar sound, has been called a 
“ croupy" cough. The attack comes on usually about midnight. 
The child is awakened from a sound sleep by coughing and violent 
efforts to get his breath. The face becomes blue and presents an 
anxious expression. These symptoms usually cease abruptly in an 
hour or two and the child resumes its slumber. The attack may be 
repeated on subsequent nights. 

Treatment .—Simple means often have a wonderful effect in re¬ 
lieving a spasm. Sometimes passing the finger down the throat will 
have this effect. A warm bath may break up an attack. The best 
method, however, is to give a teaspoonful of tincture of ipecac, 
followed by a little milk. This causes vomiting and relieves the 
condition. 

BRONCHO-PNEUMONIA. 

This is a disease that occurs principally in young children. It 
differs from lobar pneumonia (described on p. 110) in that it attacks 
both lungs, whereas lobar pneumonia usually attacks only one lung. 
Although broncho-pneumonia may affect an entire lobe, it usually 
confines itself to some of the small endings of the bronchial tubes 
and the air vesicles in immediate relation thereto. It is due to the 
same germ—pneumococcus—which causes lobar pneumonia. 


PREVENTION OF DISEASE AND CARE OF SICK. 


159 


Symptoms .—The symptoms are similar to those of a severe bron¬ 
chitis, which has been described under “ Coughs and colds,” on page 
157. They consist of a loud, harsh cough, accompanied by pain, 
shortness of breath, and fever. The cough is attended with a glairy 
and tenacious expectoration, which may be blood tinged. The tem¬ 
perature may rise as high as 104° or 105° F. The shortness of 
breath is very distressing; the respirations sometimes amount to as 
high as 60 or 80 per minute. The pulse is frequent and may be rapid, 
feeble, and irregular. Recovery generally occurs in two or three 
days, but many cases last for several weeks. 

Prevention .— Other children should be kept away from the patient 
and care should be taken to boil all sheets, pillowcases, and other 
articles which come immediately in contact with the patient. Sepa¬ 
rate dishes should be used, and they should be scalded with hot 
water after heino* in the sick room. The child’s mouth should be 

O 

carefully wiped with tissue paper, and the paper immediately burned. 
This condition frequently follows measles, whooping cough, and 
common colds. Children suffering from these affections should be 
given careful attention and not be allowed to expose themselves to 
cold until they have fully recovered; otherwise this form of pneu¬ 
monia may develop. 

Treatment .—The sick room should be well ventilated with the 
temperature kept at about 70° F. A croup kettle (described on p. 
158) should be employed to keep the air around the bed moist. A 
large mustard plaster may be applied over the chest. This should 
be made in accordance with instructions given on page 310 and 
should be allowed to remain on only a sufficient length of time to 
redden the skin. One grain of calomel should be given in broken 
doses, one-tenth of a grain every 10 minutes until the whole amount 
has been administered. The calomel should be followed in a few 
hours by a Seidletz powder or a small dose of salts. In cases where 
it is not possible to give the salts on account of the quick breathing 
of the child, a glycerin suppository may be employed instead. If 
there is very much pain, a Dover’s powder may be given, 3 grains 
being a dose for a child 5 years of age. This may be repeated several 
times, but it is not best to give it very often, as it interferes with 
the discharge of the secretion from the lungs. In some instances, 
this secretion blocks up the lungs and the child becomes blue. In 
that case a teaspoonful of sirup of ipecac should be given with a 
little milk to produce vomiting. Vomiting assists the bronchioles 
in clearing themselves of the secretion. One of the best expectorants 
is compound sirup of squills in doses of 4 drops for a child 5 years 
of age. This may be given every two hours, but if it produces nausea 
the dose should be reduced. 


160 


PREVENTION OF DISEASE AND CARE OF SICK. 


PLEURISY. 

Pleurisy sometimes follows exposure to cold or wet. Usually, 
however, there is an underlying diseased condition present, such as 
tuberculosis, rheumatism, gout, chronic alcoholism, or heart or kidney 
disease. It may arise as an extension of inflammation from the 
lungs and their neighboring organs, being more common with lung 
fever, the pneumonia of adults, than with bronchial pneumonia, 
the pneumonia of children. Pleurisy may also follow injury to the 
chest wall. 

Symptoms .—The first sign is a pain in the chest, often called a 
u stitch in the side/* which is worse when breathing rapidly or mov¬ 
ing around. There is a dry distressing cough which the patient tries 
to restrain in order to avoid the pain which it causes. The usual signs 
of fever, such as an increased pulse rate, hot skin, and flushed face 
are present. After a day or two there may be an effusion of fluid 
into the pleural sac. When this occurs pain will be less but the 
breathing will be more difficult. In favorable cases, this fluid is 
absorbed in a few weeks and the patient recovers; when this does not 
occur, the physician has to draw it off through a hollow needle. 

Prevention .—The best way to prevent pleurisy is to keep the body 
as healthy as possible; then it is not so liable to be affected by cold 
and wet. Every person should live out doors as much as he can 
and see that there is plenty of fresh air present when he has to remain 
indoors. During sleeping hours, windows in bedrooms should be 
kept open. Persons who suffer from gout or rheumatism should be 
especially careful not to expose themselves to inclement weather. 

Treatment .—In order to lessen the pain the patient should be put 
to bed and the affected side should be strapped with strips of ad¬ 
hesive plaster. This is done by taking 4-inch strips and applying 
them as tightly as possible from the middle of the chest in front 
to the center of the back. Other strips are then applied, each one 
slightly overlapping the one above until five or six of the strips have 
been placed in position. Cold applied to the side by means of ice 
or ice water in a rubber bag will often relieve pain. In some cases 
morphine has to be given in doses of one-sixth to one-fourth of a 
grain, but this should not be used if it can be avoided and the dose 
should not be repeated unless the severity of the pain demands it. 
One-half a teaspoonful of paregoric may be given instead of the 
morphine. 

HEART DISEASE. 

Heart disease is a condition which often follows syphilis, diphthe¬ 
ria, scarlet fever, acute rheumatism, chorea, or tonsillitis. It may be 
caused by the persistent use of alcoholic liquors, or by the absorption 


PREVENTION OF DISEASE AND CARE OF SICK. 


161 


of small quantities of lead, as in the case of house painters, those who 
use hair dyes or drink water from lead pipes. It may be a part of 
a general process, known as arteriosclerosis, in which there is a 
hardening and loss of elasticity of the walls of the arteries, including 
the arteries which supply the heart muscle. 

Symptoms .—The symptoms of heart disease are due to a dilatation 
of the chambers of the heart caused by the backing up of blood in 
them; this results from imperfect closure of the heart valves or from 
weakening of the heart muscle. In some cases thickening of the 
muscular walls of the heart occurs, which compensates for the en¬ 
largement of its cavities, as the extra strength of the heart muscle 
enables it to force out at each contraction of the heart the addi¬ 
tional amount of blood contained in its cavities. In such cases 
there may be no symptoms, but when the heart muscle begins to 
fail the symptoms appear. There is shortness of breath, coughing, 
spitting of blood, indigestion, headache, dizziness, blueness of the 
skin, dropsy, irritability, delusions, delirium, or melancholia. Be¬ 
sides these symptoms there are special symptoms referable to the 
organ itself, such as: 

Palpitation .—Palpitation means that the heart beats are irregu¬ 
lar, rapid in action, and perceptible to the patient. It may be 
accompanied by shortness of breath. Its chief causes are mental 
excitement, excessive smoking, dyspepsia, overindulgence in tea, 
coffee, or alcoholic liquors. It often occurs in young soldiers, ath¬ 
letes, and those whose duties require inordinate muscular exertion. 

Breast pang (angina pectoris ).—There are two forms of breast 
pang, one in which the patient is seized with a sudden, violent pain 
of the heart, attended by a sense of impending death. The face 
is pale, the skin is covered with a cold sweat, and the breathing is 
shallow or it'may even stop while the pain lasts. This pain radi¬ 
ates over the left shoulder and arm and usually passes off in a few 
seconds or minutes. The person may die during the attack or the 
attack may recur after an interval of a few days or not for many 
years. The other, or mild form of angina pectoris, occurs mostly 
in nervous persons and is usually due to overexertion or indiscre¬ 
tion is eating. The pain is less intense, but lasts longer and is 
usually relieved by the eructation of gas from the stomach. 

Fainting .—This is caused by anemia of the brain due to inefficient 
action of the heart or vascular relaxation. During the fainting fit 
the patient is often unconscious. The spell may be preceded by a 
short period of vertigo or the patient may complain that everything 
has turned black before his eyes. 

Prevention .—Children should not be allowed to take active ex¬ 
ercise after they have had measles, scarlet fever, or diphtheria; after 


162 


PREVENTION OF DISEASE AND CARE OF SICK. 


an attack of acute rheumatism the patient should be kept quiet until 
all danger of injury to the heart is passed. Those who suffer from 
infected tonsils should have the latter removed. A dentist should 
be consulted frequently in order to ascertain if there is any pus 
around the roots of the teeth. Such pus, if discovered, should be 
drained to prevent the absorption of poisons which may injure the 
heart. Alcohol and tobacco should not be indulged in to excess as 
irregularity of the heart’s action often follows their use. Persons 
who have led sedentary lives should not suddenly ta,ke up athletics 
or engage in occupations which require sustained muscular effort as 
the heart muscle is liable to be injured thereby. Such a change, if 
made, should be a gradual one in order that the heart may accommo¬ 
date itself to the extra work required of it. 

Treatment *—Special care should be taken not to eat indigestible 
articles, as gas produced in the stomach and intestines by the fer¬ 
mentation of such food may cause pressure on the heart and inter¬ 
fere with its action. Only such work or exercise should be under¬ 
taken as will not put a strain upon the heart as otherwise compensa¬ 
tion may be broken and serious symptoms result. Such symptoms 
may be relieved by administering a teaspoonful of aromatic spirits 
of ammonia in water or a teaspoonful of bicarbonate of soda in a 
glass of hot water. It may be necessary to give a quarter of a grain 
of morphine sulphate with a one one-hundred-and-twentieth of a 
grain of atropine sulphate. If the patient faints, her clothes should 
be loosened and she should be laid flat upon a couch or the floor with 
the head lowered. When there is shortness of breath the patient is 
usually more comfortable sitting up and should be allowed to rest 
in an easy chair or be propped up in bed. Every person with chronic 
heart disease should place himself under the care of a physician and 
follow his directions. 

SORE MOUTH. 

This condition is met with more in children than in grown persons. 
Its chief causes are improper cleansing of the mouth, bad teeth, ex¬ 
cessive use of mercury, and occasionally it accompanies scarlet fever, 
measles, tonsillitis, or sore throat. 

Symptoms .—There is redness of the lining membrane of the mouth. 
The lips and gums may be swollen and the tongue indented by teeth 
marks. The saliva is increased and often dribbles from the corner 
of the mouth. The changes in this secretion may produce a disagree¬ 
able taste and cause the breath to be foul. There is pain and distress 
on taking food. Little white spots may appear, which in bad cases 
may terminate in small ulcers. 

Treatment .—The baby’s mouth should be carefully cleansed at 
least once each day with a clean cloth soaked in a solution of boric 


PREVENT ION OF DISEASE AND CARE OF SICK. 


163 


acid (a teaspoonful of boric acid in a glass of hot water). If the 
mouth becomes sore, this solution should be used frequently, and 
especially after each meal. If the inflammation is severe, the mouth 
should be carefully swabbed out with a solution of nitrate of silver 
(silver nitrate, 1 grain; water, 1 ounce) or with a solution of car¬ 
bolic acid (carbolic acid, 1 grain; water, 1 ounce). Only a small 
amount of either solution—just enough to wet the swab—should be 
employed. The swab is best made by tying a little absorbent cotton 
on a small stick. Ulcers will often heal if touched with a piece of 
lunar caustic after carefully drying the surface. Spongy gums may 
be relieved by the application of tincture of myrrh diluted with 
equal parts of water. 

SORE THROAT (TONSILLITIS, QUINSY). 

Sore throat is a common disease. It is usually the result of expo¬ 
sure to wet and cold. Talking, laughing, or shouting in a damp, 
cold atmosphere is sometimes the cause of it. It may accompany or 
be an extension from an ordinary “ cold in the head.” It is a com¬ 
plication of diphtheria, scarlet fever, smallpox, tuberculosis, and 
syphilis. It is caused also by drinking milk drawn from cows with 
sores on their teats. Sometimes the inflammation is limited to the 
mucous membrane of the pharynx and soft palate; it is then known 
as pharyngitis or acute catarrhal sore throat. More frequently the 
tonsils are affected, and the inflammation is then called tonsillitis. 
When the inflammation is more deeply seated behind the tonsil and 
tends to suppurate or form an abscess, the term “ quinsy ” is applied. 
An attack of sore throat may last from 2 to 10 days, or longer. 

Symptoms of acute sore throat are chilliness and feverishness, 
pain or soreness on swallowing, dryness, or a tickling or scratching 
sensation in the throat. 

There is liable to be stiffness and some tenderness along the side of 
the neck. If one or both tonsils are involved, as they usually are 
to a greater or less extent, the symptoms are more severe. In marked 
cases examination shows redness and swelling of the parts affected- 
swollen tonsils (tonsillitis) and white or cream-colored spots may be 
seen on the surface of one or both tonsils. (This form of the disease 
is frequently mistaken for diphtheria.) There may be high fever 
and great prostration. 

In the severest form of tonsillitis (quinsy) the tonsil is hard and 
swollen to twice or three times its natural size, and the patient 
is unable to swallow or to open his mouth beyond a fraction of an 
inch. The saliva dribbles away; if suppuration occurs the tonsil 
gradually softens until the abscess breaks. With the discharge of 
pus the severe pain is relieved and the patient rapidly recovers. 


164 


PREVENTION OF DISEASE AND CARE OF SICK. 


If the abscess is large, and if the pus is discharged in a backward 
direction there is danger from suffocation, particularly if the abscess 
break during sleep. Fortunately the abscess usually points toward 
the mouth, and the pus runs out. 

Treatment .—Persons who are subject to attacks of sore throat 
should keep their feet dry and be careful not to catch cold. If a 
case develop, give a gargle of salt water or potassium chlorate and 
water (saturated solution), or boric acid and water may be applied 
to the tonsil. Dry bicarbonate of soda (baking soda) is highly 
recommended as a local application, a small quantity to be applied 
every hour. Apply cold water or a light ice bag to the neck, or a 
thick piece of flannel saturated with ice water may be placed around 
the neck and covered with muslin. Small pieces of ice placed in 
the mouth are usually agreeable. The bowels should be kept open 
by means of Epsom salts. 

If the cold applications to the neck do not give relief, or if they 
are not agreeable to the patient, apply hot water or poultices and 
give hot gargles, or let the patient gargle with hot tea. If the swell¬ 
ing is very great, he can not gargle. If practicable, send for a 
physician. 

DYSPEPSIA. 

Dyspepsia is only a symptom of disease, and is often not due to 
the disease of the stomach itself. There are only two serious diseases 
of the stomach, ulcer and cancer, neither of which is a common 
complaint. Dyspepsia may result from nervousness. Emotional 
dyspepsia is very common. Everyone knows how bad news or worry 
will interfere with digestion and be followed by distress after a 
meal. Consumption is often accompanied by stomach trouble; in 
fact, this may be the only complaint made by a patient suffering 
from this disease. Disease of the heart, especially such as causes 
stagnation of blood in the abdominal organs; of the liver, such as 
is produced by alcohol or gallstone; of the intestines, particularly 
if there is constipation or obstruction of the free passage of the 
bowel contents; of the kidneys, as in chronic inflammation of those 
organs, where the waste products of the body are not fully elimi¬ 
nated; of the brain, as where there is a tumor or inflammation of 
the cerebral membranes—all give rise to stomach symptoms. 

Symptoms .—There may be only a sense of fullness or distress 
after eating; there may be a burning or gnawing sensation in the 
center of the upper part of the abdomen or severe paroxysms of 
pain which double the patient up. These symptoms may be accom¬ 
panied by nausea and vomiting or the eructation of gas or sour 
liquid. Gas may be passed from the intestines. The patient is 
inclined to be despondent and take a gloomy view of things in gen- 


PREVENTION OF DISEASE AND CARE OF SICK. 


165 


eral. There may be an absence of appetite, with weakness and loss 
of weight, resulting from the taking of an insufficient amount of 
food. 

Pre vent-ion. —If a person has no serious disease he should be able 
to digest without distress nearly all classes of food. The cutting out 
from a diet of certain substances, such as fats, starches, or meats, 
may give rise to constipation and intestinal fermentation, which 
result in dyspepsia. It is not a good practice, therefore, to limit 
oneself to certain foods unless it is done under the order of a 
physician or until, after repeated trials, it is found that certain 
articles always disagree. Very often the fault is not in the food 
but in the state of mind of the eater. The simplest articles of food 
will sometimes cause dyspepsia if one is subject to Avorry of any sort. 
Constipation is one of the chief causes of dyspepsia, and its avoid¬ 
ance will often preAent this condition arising. 

Treatment .—A teaspoonful to a tablespoonful of milk of magnesia 
taken every three hours Avill often allay dyspeptic symptoms. This 
medicine neutralizes the increased aciditA r of the stomach contents 
and also opens the boAvels. A teaspoonful of bicarbonate of soda in 
a glass of water one hour after meals frequently acts as a pre¬ 
ventive. Twenty grains of subcarbonate of bismuth taken with 
this soda is of value, but it may increase the tendency to constipation. 
A good plan is to alternate them; when the boAvels are too loose, take 
bismuth; when constipated, use magnesia. A little peppermint added 
to these mixtures makes them more palatable. During an acute 
attack of dyspepsia it may be necessary to reduce the diet and 
only take a little milk or thin soup, but no permanent change in 
the diet should be made Avithout the advice of a physician, as the 
dyspepsia may not only not be diminished thereby but it may even 
be increased by such a course. Great care should be taken to keep 
the boAvels open by going to the closet at a regular time each day, 
even if there is no disposition for the boAvels to move, by eating 
articles containing plenty of cellulose, such as coarse bread, Avhole- 
Avlieat bread, oatmeal, etc. This substance forms part of the residue 
remaining after digestion and stimulates.the intestines to contract, 
thus pushing the contents along. Fats, especially in children, tend 
to prevent constipation, and their absence from the diet will often 
cause this condition. Olive oil used in the form of salad dressing 
is one of the best means of correcting constipation. Fruits will often 
act in the same w T ay. Cooked fruit, although not as efficacious as 
raw fruit in its action on the bowels, is less liable to disagree. Laxa¬ 
tives such as licorice powders, cascara, aloin, agar-agar, and Russian 
oil are often employed, but it is best not to use laxatives if the 
boAvels can be regulated by the eating of a proper diet. Purgatives 




13 + 14 


o 



166 


PREVENTION OF DISEASE AND CARE OF SICK. 


such as salts, calomel, and jalap, which are somewhat violent in their 
action, should be rarely used, and then only when their need is 
clearly indicated. 

DIARRHEA. 

Acute diarrhea is caused by acute inflammation or by irritation of 
the intestines. It may occur as a complication in many different 
di seases. It is usually one of the symptoms of typhoid fever. It is 
not infrequently met with in severe cases of malaria. It is called 
functional or simple diarrhea when it occurs independently of any 
other appreciable disease. It may be caused by exposure to cold or 
bv errors in diet. 

In simple diarrhea there may or may not be griping and colicky 
pains. In the more severe forms the tongue is coated and there is 
some fever. Thirst is marked in proportion to the size and frequency 
of the thin or watery discharges. If the rectum is affected, there is a 
constant desire to go to stool, and a burning sensation and bearing- 
down pain, as in dysentery. 

Diarrhea may last from a few hours to as many days, or longer. 
It may become chronic. 

Treatment .—In all cases, rest and light diet. In the milder forms 
nothing further may be required. Twenty grains of bismuth sub¬ 
nitrate with 5 grains of salol may be given every three hours. In 
the more severe forms it is a good plan to begin with a dose of 1 or 
2 tablespoonfuls of castor oil, to which 10 or 12 drops of laudanum 
may be added, or in place of the oil and laudanum Epsom salt may 
be given. The diet should be limited to light articles, such as corn¬ 
starch, gruel, weak broths, soft-boiled eggs, milk, and thoroughly 
toasted bread. As a rule, in very acute cases, the less food and 
drink taken the better. The patient should rest in bed and keep his 
body warm. 

After the bowels have been freely moved by the oil or salts, if the 
diarrhea or pain continues, give one camphor and opium pill, and, if 
necessary, repeat the dose after an interval of three or four hours. 
If nausea and vomiting .occur, apply mustard to the region of the 
stomach and give tablespoonful doses of equal parts of milk and 
limewater. 

In chronic diarrhea careful attention to diet is of the greatest im¬ 
portance. The treatment is about the same as for chronic dysentery. 

CHOLERA MORBUS (SPORADIC CHOLERA). 

Cholera morbus is an affection of the stomach and intestines, at¬ 
tended by vomiting, purging, and cramps. It comes on suddenly, 
and may begin by vomiting or purging. It is usually met with dur¬ 
ing the hot months of summer. It is frequently caused by eating 


PREVENTION OF DISEASE AND CARE OF SICK. 


167 


unripe and indigestible fruits and vegetables, decomposed or im¬ 
properly cooked fish, shellfish, or salad mixtures. Drinking large 
quantities of ice water and sudden checking of the perspiration, or 
irritants of any kind, may set up the trouble. The disease usually 
begins suddenly, often at night, with vomiting, after a feeling of 
uneasiness, nausea, or a severe cramp. The contents of the stomach 
are first thrown up, then a bilious matter. The stools are at first 
solid or semisolid, but the}^ soon become more watery, lose their color, 
and sometimes appear not unlike the rice-water stools of genuine 
Asiatic cholera. The patient soon has a wasted look. His thirst 
is unquenchable. His skin may become cold and clammy and the 
pulse very weak. Cramps may occur in the feet and in the calves 
of the legs. The disease runs a rapid course. The acute symptoms 
may subside in a few hours. The attack seldom lasts more thaw 
1*2 hours. Recovery is the rule, but treatment should be promptly 
applied. 

Treatment .—Apply a large mustard plaster to the abdomen. Give 
15 drops of laudanum. If the dose is rejected (immediately vom¬ 
ited), try it again. One-quarter grain of morphine sulphate may be 
given instead of the laudanum. If it is still not retained, then try *2 
tablets of Sun Cholera Mixture. If vomiting quickly occurs, then 
inject into the rectum bv means of a glass or rubber syringe about 20 
drops of laudanum mixed with a little thin starch or a little water. 
The rectal injection should be given immediately after an evacuation, 
and the patient should be instructed to hold it as long as possible. 
In whatever way the remedy is given, the dose should be repeated in 
about one hour if the vomiting and purging continue. 

It must not be forgotten, however, that all these remedies contain 
opium, and that if the patient is inclined to sleep or shows other 
constitutional effect of the drug the dose must not be repeated. 

The nausea and thirst may be controlled by cracked ice placed in 
the mouth. Small quantities of carbonated water may be allowed. 
If the thirst is very urgent a tablespoonful of iced water may be 
given at short intervals. 

COLIC. 


Intestinal or spasmodic colic .—These terms are applied to abdom¬ 
inal pain occurring in paroxysms of different degrees of severity. 
The pain is usually referred to the region of the navel or middle 
of the belly. It may be due to indigestible food, cold or acid drinks, 
poisons, gases, or any irritating substance. It is often preceded by 
obstinate constipation. Vomiting frequently occurs. 

Another variety of colic, called lead colic or painter’s colic, is 
caused by lead poisoning. It is not uncommon in painters or work¬ 
ers in lead. It may be caused by drinking water taken from lead 


168 PREVENTION OF DISEASE AND CARE OF SICK. 

pipes. An attack may be mild or exceedingly severe. It is usually 
attended obstinate constipation and by contraction of the abdo¬ 
men. 

The severe paroxysmal pain attending the passage of a gallstone 
from the gall bladdder to the intestine is called biliary colic. In 
biliary colic the pain is usually most marked in the region above the 
navel or about the stomach (epigastric region). The paroxysms 
begin and end suddenly. Severe nausea and vomiting occur. The 
skin and eyes maj r become yellow or of a yellowish hue (jaundiced). 
Gallstones may occasionally be found in the stools, if carefully looked 
for. Some cases, however, are difficult to distinguish from ordinary 
intestinal colic. 

The severe excruciating pain caused by the passage of a small 
rough stone or calculus or particles of sandy substance from the 
kidney through the ureter to the urinary bladdder is called nephritic 
colic, kidney colic, or an attack of “the gravel.” The pain usually 
begins with a one-sided, boring backache. Suddenly it increases in 
intensity and shoots down the loin to the hip and thigh, and the 
patient writhes in agony until the “ stone ” or particle, sometimes 
not larger than the head of a medium-sized pin, reaches the bladder, 
when the pain suddenly ceases. The paroxysm may last from half 
an hour to a number of hours, or one or two days. It may not recur 
for months or years; on the other hand, there may be two or more 
paroxysms at comparatively short intervals. 

Colicky pains are present in many different diseases. Appendicitis 
frequently begins with pain not unlike that of intestinal colic. (See 
p. 169.) 

Treatment .—If the colic is due to indigestible food, or too much 
food of any kind, an emetic should be given, such as mustard and 
water. 

After the stomach is emptied give a teaspoonful of aromatic spirits 
of ammonia in water. Apply a large mustard plaster or a hot poul¬ 
tice or cloths wrung out of hot water, or heat of any kind to the 
abdomen. (Local applications of hot water usually afford some 
relief in any variety of colic or wherever pain exists.) If the colicky 
pains persist, 10 or 12 drops of laudanum or one-quarter grain of 
morphine sulphate should be given by the mouth, and repeated, if 
necessary, in two hours; or 30 or 40 drops of laudanum in a little 
water or starch may be injected into the rectum. 

If the bowels were constipated when the attack began, an injection 
of soap and warm water should be given by the rectum, or small 
doses of Epsom salt or castor oil may be given by the mouth. The 
diet for a day or two should be light food in small quantities at a 
time. The treatment for lead colic is about the same, except that 
the constipation should be relieved at once by full doses of Epsom 


PREVENTION OF DISEASE AND CARE OF SICK. 


169 


salt or castor oil. Apply heat to the abdomen or place the patient 
in a warm bath. Pressure applied to the abdomen affords some 
relief. Remove the cause or remove the patient from the cause of 
the disease. 

In biliary colic the bowels should be freely moved, patient should 
be placed in a hot bath, and laudanum. BO drops, given to relieve 
pain. 

In nephritic or kidney colic hot baths and laudanum, 30 drops, are 
the remedies. For the treatment of infantile colic see p. 193. 

In no case should paregoric , laudanum or other opiates he given in 
baby colic. 

APPENDICITIS. 

Appendicitis is an inflammation involving .the appendix vermi¬ 
form is. This is a small attachment of the large intestine situated in 
the right lower portion of the abdomen. It may begin suddenly with 
violent pains in this region, some fever, colicky pains, nausea, and 
vomiting. The seat of the pain is usually on a line drawn between 
the bony prominence (the large bone of the pelvis) just above and on 
the outer side of the right groin and the navel. As the attack pro¬ 
gresses, that region of the abdomen may become hard like a board 
and exceedingly sensitive to (he touch. Often you will find that 
the patient bends the right leg on the abdomen, and the effort to 
straighten it out causes him great pain. Sometimes the attack is 
much milder, with only an uneasy sensation in the affected region, 
very slight fever, if any, and a sense of tenderness over the part 
affected. This pain may be in the pit of the stomach or about the 
navel. 

After this pain has been present for a few days a swelling may 
appear, due to the formation of pus or to a large protective exuda¬ 
tion of lymph. 

Treatment .—The right course to pursue in a case of appendicitis is 
to immediately call a surgeon. If tlu services of a surgeon or physi¬ 
cian can not be secured, the plan of treatment should be as follows: 
Absolute rest in bed with an ice bag over the appendix, to be con¬ 
tinued during the stage of severe pain. Do not give purgatives. Only 
a small quantity of liquid diet should be given. If the pain is severe, 
20 drops of laudanum or a quarter grain of morphia sulphate in a 
little water may be given to control it. If the bowels move, a bed- 
pan should be used, and under no circumstances should the patient 
be allowed to get up. 

PILES. 

Piles are varicose dilatations of the veins of the rectum. The 
symptoms may be slight or severe. Inflamed piles are very painful. 
There is a constant burning sensation at the anus, which is greatly 
increased during and immediately after each movement of the bowels. 


170 


PREVENTION OF DISEASE AND CARE OF SICK. 


When the veins rupture you have “ bleeding piles.” Occasionally the 
inflammation of a nodule results in an abscess. 

Treatment .—Piles are frequently due to habitual constipation, and 
when that condition is remedied the piles often disappear, or at least 
cease to be troublesome. The bowels should be kept in good condi¬ 
tion. One easy movement should take place regularly every day. 
This desirable habit should be brought about by careful attention to 
diet and by drinking water in the morning before breakfast rather 
than by the use of cathartics. 

In acute attacks, if the bowels are constipated, give a full dose of 
Epsom salt; put the patient on light, soft diet. Apply ice to the 
anus or inject cold water into the rectum. An ointment composed of 
5 grains of menthol mixed with 2 tablespoonfuls of vaseline often 
affords great relief. If the piles protrude, especially if they become 
strangulated, they should be pushed back with the finger; olive oil or 
vaseline may be applied. If the piles are large and persistently pain¬ 
ful, see a surgeon and have them removed by operation, which is the 
only sure cure. 

KIDNEY DISEASE (NEPHRITIS). 

Acute nephnntis .—This condition follows exposure to cold and 
dampness, extensive burns, alcoholic* intemperance, poisoning from 
turpentine, potassium chlorate, carbolic acid, cantharides, mercury, 
and lead. It may also be a sequel of scarlet fever, diphtheria, typhoid 
fever, smallpox, pneumonia, and a complication of tuberculosis. It 
occurs in pregnancy, being probably due to renal congestion caused 
by the mechanical pressure of the womb, or to the altered blood 
condition. 

Symptoms .—The quantity of urine is diminished from 40 to 50 
ounces a day to from 5 to 20 ounces a day. The color is a dark red 
or brown and it will be found to contain albumen if a teaspoonful 
is boiled with a few drops of vinegar. The presence of albumen is 
shown by the formation of a cloud in the urine and a deposit will 
settle upon the bottom upon cooling. Normal urine does not con¬ 
tain albumen. Other symptoms present may be headache, nausea, 
vomiting, shortness of breath, diarrhea, dropsy, convulsions, or un¬ 
consciousness. 

Chronic nephritis .—Chronic nephritis may follow an acute attack. 
It more often, however, comes on slowly without acute manifestation. 
Drinkers of beer and other alcoholic liquors and those who eat large 
quantities of meat seem to be liable to the disease. Syphilis and 
malaria also cause nephritis. It is one of the results of old age, 
nearly all old persons having at least some symptoms of the disease. 

Symptoms .—The symptoms of chronic nephritis are similar to 
those of the acute disease, but they may manifest themselves in a mild 


PREVENTION OF DISEASE AND CARE OF SICK. 


171 


form, so mild that a diagnosis can not be made until the urine is 
examined. In one form of the disease the urine is of a pale yellowish 
color and may be greatly increased in quantity, sometimes from 2 to 
4 quarts being passed in a day. There may be only a trace of 
albumen or it may be absent altogether at times. 

Treatment .—The treatment of the acute form and the chronic 
form when acute symptoms intervene is profuse sweating and free 
catharsis. The sweating may be produced by wrapping the patient 
in a sheet wrung out of hot water and then rolling him up in 
blankets. Children may be given a hot bath and then wrapped up in 
blankets. Sometimes a frame to which a number of electric lights 
are attached is placed over the patient when lying in bed and the 
whole covered with blankets. When the lights are turned on the 
heat of the lamps causes the patient to sweat. The patient should 
be watched and at any evidence of exhaustion the sweating should 
be discontinued. Catharsis is best produced by salts, either Epsom 
or Rochelle. The patient should be placed upon a milk diet and be 
given plenty of water to drink. 

Persons suffering from the chronic form of the disease should be 
careful not to expose themselves to cold and wet, should eat sparingly 
of red meats, and avoid alcoholic drinks. If dropsy is present a salt- 
free diet is indicated. If possible, the patient should live in a warm, 
dry climate. 

DELIRIUM TREMENS. 

Delirium tremens occurs as an incident in the life of persons ad¬ 
dicted to the excessive use of intoxicating liquors. 

Loss of appetite, sleeplessness, or a marked mental depression are 
the chief symptoms of the first stage of the affection which is known 
among drunkards as “ the horrors.” 

As the disease advances the patient talks incoherently; has a wild 
expression; his mind wanders from one thing to another. He an¬ 
swers questions in a rambling manner. He fancies he is being pur¬ 
sued bv wild animals or that he sees rats, snakes, and other animals 
*/ * • 

crawling on the walls or around his bed, or he may imagine himself 
to be engaged in his regular duties or as master of a ship, giving 
directions to the men. 

The delirium is always worse at night, but the patient requires 
careful watching all the time. He may try to jump out of a window 
or commit suicide. 

Delirium tremens may be confounded with acute inflammation of 
the brain or with acute mania (insanity) or with certain forms of 
pneumonia, and any one of these, diseases may also be present. 
Pneumonia is a frequent complication of delirium tremens, and in 
fatal cases may be the direct cause of death. 


172 PREVENTION OF DISEASE AND CARE OF SICK. 

In favorable cases the symptoms begin to improve in three or four 
days from the onset. The patient sleeps and gradually recovers. 

Treatment .—The patient requires constant attendance. Physical 
restraint should be avoided if possible. To support the patient and 
to procure sleep are the great objects of treatment. Careful feeding 
is very important. Milk or concentrated broths should be given at 
regular intervals of two hours. A cold bath is of value in some 
cases, especially if agreeable to the patient. In other cases a warm 
bath or a hot foot bath may have a better effect. 

The serious symptoms are largely, if not entirely, due to the sleep¬ 
lessness, and if several hours of sound sleep can be procured improve¬ 
ment is almost sure to follow. To this end bromide of potash, in 
30-grain doses, may be given in water every three hours. Morphine 
or opium are not to be recommended in this disease, except under 
the immediate direction of a physician. All stimulants should be 
withheld, except in rare cases when the pulse is weak. The giving of 
whisky, gin, etc., in small doses to gradually “ sober him up,” is a 
bad practice, as it delays the patient’s recovery. No amount of beg¬ 
ging for stimulants on the part of the patient should persuade his 
attendants to break this rule. 

SUNSTROKE. 

The term “ sunstroke ” denotes a sudden attack of illness from 
exposure or prolonged exposure to the rays of the sun; but the same 
condition may be produced in hot weather by exposure to high tem¬ 
perature not in the direct rays of the sun, particularly if the person 
is engaged at hard work in close quarters. Stokers on steamships are 
sometimes affected by the heat of the furnace. Men debilitated from 
or addicted to the excessive use of stimulants are more apt to suffer 
than those of temperate habits. 

Sunstroke occurs in two forms: Heat stroke (heat fever), in which 
the temperature of the body is very high, and heat prostration or 
heat exhaustion, in which the surface of the body is cool, sometimes 
considerably below normal. The difference is very important because 
of the different treatment required. 

In severe cases of heat stroke the patient may be stricken down 
in a state of unconsciousness and die instantly or within an hour or 
two. In other cases there may be intense headache, dizziness, marked 
restlessness, nausea and vomiting, and hot “burning” skin. The 
thermometer may register 105° F. Pulse is full and may be slow T or 
fast. Breathing is labored, may be sighing or rattling. Patient soon 
becomes unconscious, the stupor deepens, and death may occur within 
24 hours; or the temperature may drop, consciousness may return, 
and the patient get well. 


PREVENTION OF DISEASE AND CARE OF SICK. 


17 $ 


In heat prostration, as already stated, the surface of the body is 
cool, the pulse rapid and feeble, and there is a feeling' of general 
weakness. There may he only slight faintness and nausea, and under 
prompt treatment patient may rapidly recover, or, on the other hand, 
there may be complete loss of consciousness and a rapid and fatal 
termination from exhaustion. 

Heat cramps .—Painful spasms of the muscles, especially those of 
the abdomen and limbs, may occur when persons who are exposed to 
high temperatures are required to perform hard labor. Stokers on 
steamships are liable to suffer from them. They are extremely pain¬ 
ful, making the patient cry out; there is headache, and the bowels are 
constipated. In some cases the patient is unconscious, and the con¬ 
vulsions resemble those of epilepsy. The attacks may last from 12 
to *24 hours, but even after the patient becomes quiet the spasms may 
be renewed by a slight stimulus, such as a cold draft or a sudden 
movement. The muscles are sore and the patient weak and listless 
for several days following the seizure. The cases vary greatly in 
intensity; there may be simply a slight cramp in the abdomen or in 
one of the muscles of an extremity. 

Prevention .—The temperature and humidity of inclosed places like 
firerooms of ships, weaving rooms, etc., should he regulated so as to 
prevent the temperature of the air from rising above 8(1° F. and the 
moisture 80 per cent. This may be accomplished by the use of fans 
to keep the air in motion. Cold air may be forced into these places 
or hot air exhausted by the same means. 

Treatment .—In heat stroke (fever heat) the temperature of the 
body should be reduced as rapidly as possible. Place the patient in 
a cold-water bath, add ice, rub the body with the blocks of ice, 
apply ice w ater with ice cap to his head, and keep up the treatment 
until the temperature, as shown by the thermometer in the rectum, 
is reduced to 100° F. If the temperature rises again, repeat the 
treatment. If symptoms of exhaustion folloAv the reduction of the 
temperature, stimulants should be given—strychnine sulphate, one- 
fortieth grain. 

In heat prostration, with cool skin, weak and rapid pulse, stimu¬ 
lants and friction are required. Give strychnine sulphate, one- 
fortieth grain, rub the surface of the body and the extremities, place 
hot-water bottles to the feet, and cover the body with blankets. If 
the head is hot, apply cold water to the forehead. If vomiting 
occurs, inject hot salt solution (one teaspoonful of salt to a pint of 
water) .into the rectum. Apply a mustard plaster over the region 
of the stomach. Mustard plasters may also be applied to the feet. 

Heat, cramps .—Twenty drops of tincture of nux vomica in a glass 
of water taken three times a day will often prevent these cramps. 


174 


PREVENTION OE DISEASE AND CARE OF SICK. 


Oatmeal water should be used by the firemen to quench their thirst. 
If a fireman feels faint, a cup of strong tea will frequently revive 
him. The minor spasms in the muscles of the arms and legs are 
usually treated by the men themselves by rubbing each other. When 
the cramps are severe the patient should be placed in a hot bath, the 
muscles vigorously rubbed, and large quantities of hot water given 
by the mouth and injected into the bowel. Thirty grains of bromide 
of potash should be given in half a glass of water. If the patient 
can not retain this, 60 grains in a pint of water should be adminis¬ 
tered by the rectum. The next day every effort should be made to 
get the patient’s bowels opened by giving him castor oil or salts or 
by injection of soapy water. 

• 

HEADACHE. 

Headache is a symptom of disease of some portion of the body. 
When it is unilateral, localized, sharp, and paroxysmal it is known 
as neuralgia. It may be caused by many conditions, among which 
may be mentioned derangements of the stomach and liver, constipa¬ 
tion, neurasthenia, eyestrain, heat exhaustion, exposure to cold and 
dampness, inflammation of the kidneys or genital organs. It is pres¬ 
ent in malarial fever, typhoid fever, smallpox, syphilis, diabetes, and 
influenza. In meningitis or inflammation of the coverings of the 
brain the pain in the head is excruciating. Many of the diseases of 
childhood begin with headache. 

Treatment .—Remove the cause if possible. Open the bowels with 
a dose of castor oil or salts. Take 10 grains of aspirin and repeat 
if necessary in three hours. A little hot tea and toast should be given 
with this medicine to prevent nausea. If the headaches are frequent, 
a physician should be consulted to ascertain the cause. 

CONVULSIONS. 

Convulsions are a symptom of many diseases. They commonly 
occur in children after eating indigestible food and at the beginning 
of any serious disease. They may be present in disease of the brain 
and kidneys, rickets, epilepsy, apoplexy, hysteria, after poisoning 
from many drugs, and in women during pregnancy or after the 
child is born. 

Treatment .—During an epileptic fit nothing can be done except 
to keep the patient from injuring himself. A cork or other similar 
object should be wrapped in a handkerchief and placed between the 
patient’s teeth to prevent his biting his tongue. Twenty grains of 
bromide of potash three times a day will sometimes ward off an 
attack. 


PREVENTION OF DISEASE AND CARE OF SICK. 


175 


If a child lias a convlusion, it should be put into a lukewarm 
bath. Cold compresses may at the same time be applied to its head. 
A mustard plaster may be applied to the back of the neck, being 
careful to leave it on only long enough to .redden the skin. A solu¬ 
tion containing bromide of potash (15 grains in 2 tablespoonfuls of 
water) may be injected into the child’s bowels or 5 grains may be 
given by the mouth. 

In the convulsions of pregnancy little can be done by the layman, 
except to keep the patient’s bowels open, give the patient warm baths, 
and keep her wrapped in hot blankets/ hoping to eliminate tha 
poisonous substances through the skin. If there is electricity in the 
house, an apparatus described on page 171 may be used to make the 
patient sweat. 

POISON IVY. 

Contact of the skin with poison ivy causes in many people a 
very annoying inflammation of the skin. The vine is of the climbing 
variety, with three pointed leaves on each stem. A few hours or 
about a day after the skin is exposed to the poison of this plant a red 
rash appears, with more or less swelling and itching; small blisters 
appear, filled with serum, even becoming quite large. When they 
burst there is considerable weeping from the surface. Later it may 
go on to a formation of pus. The hands and face, being the most 
exposed parts of the body, and the feet and ankles of those who go 
barefooted, are usually first affected. If the inflammation is very 
severe, there may be some incidental disturbance, such as fever, 
headache, and general feeling of malaise. 

Treatment .—One of the best treatments for this disease is bathing 
with salt water, sea water being the best. Boric acid, 1 teaspoonful 
in a glass of hot water, is a good application. The large blisters 
should be punctured and the contents allowed to run out. Every one 
or two days the affected parts should be bathed with warm Avater, 
carefully dried without rubbing, and the boric acid treatment 
resumed. 

BOILS. 

A boil is a circumscribed inflammation of the skin and connective 
tissue. It is often caused by infection following a slight wound or 
scratch of the skin, but may occur apparently without any cause. It 
begins as a small red pimple and gradually increases in size and 
forms a dusky red swelling the size of a silver dollar or less. The 
central portion of the swelling sloughs or forms a “ core,” and as 
soon as the core is separated or cast off the inflammation subsides, the 
pain lessens, and the ulcer begins to heal. 

Treatment .—Compresses made of aseptic gauze or clean white 
cotton cloth wet with a 1 to 5,000 hot solution of bichloride of mer- 


176 


PREVENTION OF DISEASE AND CARE OF SICK. 


cury should be applied every two hours until the central portion of 
the boil is softened. The bichloride solution should be made in a 
metal basin or some utensil not employed in cooking- or for holding 
drinking water. The solution should be heated each time it is used, 
and in the intervals it should be kept upon a high shelf, so that no 
person or animal may be poisoned by it. The separation of the core 
of the boil may be aided by an incision. This incision should be 
made through the thickened tissues of the edge of the boil by a thin 
sharp blade previously sterilized by boiling. The blade should be 
wrapped in cotton before'boiling, and a little soda added to the water 
to prevent the edge of the knife from becoming dull. The knife 
may also be sterilized by placing it for a half an hour in a 3 per 
cent compound cresol solution (see p. 104), which does not injure 
metals. After the core is discharged, the ulcer should be washed 
daily with the bichloride solution and dressed with dry sterile gauze. 

ABSCESS. 

An abscess is a circumscribed collection of pus. It may occur 
in any part of the body. The local symptoms are those of inflam¬ 
mation, redness, heat, pain, and swelling. There may be constitu¬ 
tional symptoms consisting of chills, fever, and sweats. A “cold 
abscess” is due to bone tuberculosis. It has received this name 
because it develops slowly and presents but few of the signs of 
inflammation. The patient may not be aware of its existence until 
a swelling is noticed. 

Treatment .—An abscess should be opened and the contents evacu¬ 
ated. A sharp knife should be disinfected by placing it for half 
an hour in a 3 per cent compound cresol solution or a 3 per cent 
carbolic acid solution. (See p. 104.) The hands should be scrubbed 
and disinfected with the same solution, and the abscess should then 
be opened by quickly plunging the blade into the abscess cavity and 
cutting outward. The abscess should then be washed out with a 
weak bichloride solution (see p. 175) and a small piece of gauze 
soaked with the solution should be left in the opening to keep it 
from closing before the abscess heals from the bottom. A gauze 
compress should then be placed over the abscess, and a bandage 
should be applied to keep it in place. The dressing should be 
renewed daily. An abscess should not be opened by a layman if it 
is possible to secure the services of a physician, as there is danger 
of doing serious injury to blood vessels and other important struc¬ 
tures if care is not exercised. If the abscess is situated near one 
of the large vessels it is better to first carefully cut through the 
skin and then open the abscess by separating the tissues with a 
blunt instrument (the end of a sterilized wooden penholder is suit- 


PREVENTION OF DISEASE AND CARE OF SICK. 177 

able for this purpose). The location of the large blood vessels is 
shown in figures 138, 139, 140, 141, 14*2, 143, 144. 

A cold abscess should not be opened by a layman. The patient 
should be kept quiet in bed until the services of a physician can be 
secured. If the abscess ruptures, a compress composed of absorbent 
cotton wrapped in gauze should be applied. Care should be taken 
by the dresser to disinfect his hands before he handles the dressing 
materials, as they should be kept as clean as possible. 

SORE EYES. 

Conjunctivitis .—This is an inflammation of the membrane cover¬ 
ing the eye. It is caused by foreign bodies, grit, and particles of 
dirt which lodge upon the eye, exposure to cold, irritating gases 
and other chemicals, and the action of numerous bacteria. It is a 
complication of many diseases, such as pneumonia, syphilis, gonor¬ 
rhea. diphtheria, measles, and influenza. 

Symptoms .—The eye is painful and feels as though there were 
grains of sand between the eyeball and the lid. This pain is in¬ 
creased by exposing the eyes to light. The eyeball is red and the 
lids are swollen. There is an increased flow of water from the eye 
which runs down over the cheeks in tears or is discharged in the 
nose through the tear duct. 

Treatment -—Che eve should be washed out everv two hours wi f h 
a solution of boric acid (one teaspoonful of boric acid :n a glass of 
hot water). In doing this the eyelids should be held apart, but 
great care should be taken not to press upon the eyeball, as it may 
be injured thereby. A few drops of a solution composed of zinc 
sulphate (4 grain; water, 1 ounce) should be dropped into the eye 
every three hours. A 10 per cent solution of argyrol or a 5 per 
cent solution of silvol may be used for the same purpose. 

Iritis .—This is an inflammation of the iris, the muscular curtain 
in the eyeball which separates the anterior from the posterior cham¬ 
ber. It is an affection which accompanies syphilis, acute rheuma¬ 
tism, diabetes, tuberculosis, gonorrhea, etc. It may occur as the 
result of extension of inflammation from other eye structures. 

Symptoms .—There is a red ring just back of the cornea (the clear 
portion of the eye which forms the front of the eyeball). The pupil 
or dark spot of the eye, instead of being round, may be oval or 
irregular in shape. The eye is painful and many of the symptoms of 
conjunctivitis are present. 

Treatment .—The eye should be washed out with boric acid solu¬ 
tion and a drop of 1 per cent solution of atropin sulphate should 
be placed in it three times a day. Keep the patient in a dark room. 

Preventable blindness. —One-half of the blindness of the world is 
said to be preventable. One-quarter of the blindness of children is 


178 PREVENTION OF DISEASE AND CARE OF SICK. 

due to gonorrhea, and one-tenth to the carelessness of the doctor or' 
midwife when the child is born. Other causes of blindness are 
trachoma, syphilis, the poisonous effects of wood alcohol, tobacco, and 
lead, uncorrected errors of refraction, injuries, and inflammation due 
to pus organisms. The blindness of the new born is due to infection 
received from the birth canal of the mother, and for this reason a 
few drops of a 1 per cent solution of nitrate of silver (4J grains of 
nitrate of silver to 1 ounce of water) or a 10 per cent solution of 
argyrol (see p. 87) should be dropped in every baby’s eyes as soon as 
it is born, except in cases where it is positively known that no infec¬ 
tion of the birth canal of the mother is present. The eyes should 
first be cleaned with a solution of boric acid, a separate piece of ab¬ 
sorbent cotton being used for each eye; the lids then carefully sepa¬ 
rated and one or two drops of the silver nitrate or argyrol solution 
placed in each eye between the outer ends of the lids, which should be 
separated so that the solution may enter the space between the eyelid 
and the eyeball. Care must be taken not to touch the delicate mem¬ 
brane of the eye with the eye dropper. Only one application of the 
solution is necessary. 

Trachoma .—Trachoma is a chronic infectious disease of the lining 
membrane of the eyelids, communicable to others by means of towels, 
handkerchiefs, fingers, or other articles which transfer the infected 
discharges from the eves of those suffering with the disease. It may 
begin as an acute inflammation, but more often its onset is insidious, 
and the patient may not be aware of its presence for some time. The 
lining membrane of the eyelids become thickened, the eyelid is heavy, 
and drops over the eyeball. In severe cases the patient shuns the light 
on account of the pain it causes. If the lids are everted, a number of 
small granular bodies, resembling sago grains, will be noticed. There 
is also a mucopurulent discharge present, more abundant in some 
cases than in others. The disease produces a roughened condition of 
the inside of the lid which irritates the front of the eyeball, causing 
an inflammation of that structure which often leads to blindness. 

Prevention. — The disease occurs among Indians and persons avIio 
live in the mountains of Kentucky, Tennessee, and Virginia, or 
who dwell in the thickly populated portions of large cities; in fact, 
it is prevalent among those persons who have not the conveniences 
to live properly. To prevent its spread, each member of the family 
should have his OAvn towel, handkerchief, and wash rag. The wash 
basin should be scalded, if used by more than one individual, after 
each washing. No person should sleep with another who has tra¬ 
choma, or on a bed that has been slept in by such a person. Chil¬ 
dren with trachoma should not be allowed to go to school until cured. 
.The patient should place himself under the care of a physician and 
strictly follow his directions. 


PREVENTION OF DISEASE AND CARE OF SICK, 


179 


EARACHE. 

The ear consists of three portions—the external, middle, and in¬ 
ternal ear. The middle ear is a little cavity which communicates 
with the nose by a small tube. It is situated at the bottom of the 

%j 

ear canal from which it is separated by the eardrum. Pain in the 
ear is usually caused by inflammation of the lining membrane of the 
middle ear. This becomes swollen and the tube leading to the nose 
is blocked up, which results in an accumulation of fluid in the middle 
ear cavity. The pressure of this fluid causes pain, which is not re¬ 
lieved until the tube becomes open or the eardrum ruptures, allowing 
the fluid to escape through the ear canal. This inflammation often 
follows cold in the head and it is much more likely to occur if there 
are adenoids, large tonsils, or other obstruction of the nose which 
renders the free passage of air difficult. Acute catarrh of the ear also 
frequently accompanies scarlet fever, measles, pneumonia, smallpox, 
typhoid fever, and tuberculosis. 

Symptoms .—Pain may be entirely absent in catarrh of the middle 
ear, but it is usually very severe. The patient also complains of full¬ 
ness in the ears, dizziness, and deafness. xV baby or child will often 
pull at its ear as if it felt some obstruction in the ear canal. When¬ 
ever a baby appears sick and the cause has not been ascertained it is 
well to think of earache. Touching or gently pulling on the ear 
makes baby cry out with pain. On account of the warmth it usually 
prefers to lie with the affected ear against the pillow. There is gen¬ 
erally a rise of temperature, but this is not always the case. The pain 
is relieved when the eardrum ruptures and there is a discharge 
of serum and pus from the ear canal. 

Prevention .—Adenoids and large tonsils should.be taken out. The 
inflammation of the lining membrane of the nose should be treated 
and bony processes or other obstructions in the nose removed. Chil¬ 
dren should sleep with the windows open at night, and if they are 
strong and robust cold tub baths should be given in the morning upon 
arising. A child should not be permitted to play with children suf¬ 
fering from colds and in the wintertime should be kept out of street 
cars and other crowded places where the danger of infection is 
greater. 

Treatment .—Heat should be applied to the ear, either by means of 
a liot-water bottle or by hot cloths. The applications should be con¬ 
tinued for half an hour and should be renewed every two hours. 
During the intervals between the application of heat the ear should 
be kept warm. A warm solution of carbolic acid and glycerin should 
be instilled in the ear—a few drops every two hours. Care should 
be taken to see that the drops run into the ear canal and are not 
merely deposited on the outside of the ear. The carbolic acid and 



180 


PREVENTION OF DISEASE AND CARE OF SICK. 


glycerin mixture is made by thoroughly mixing 1 dram of carbolic 
acid with 7 drams of glycerin. Half a grain of Dover’s powders or 
four drops of paregoric may be given to a child 1 year old, and 
proportionate doses for children of other ages. The opiate should 
not be renewed unless the pain is severe. The child’s bowels should 
be kept open by giving it a small dose of salts or castor oil. 

Accumulation of wax in ears .—Wax is secreted by numerous small 
glands in the auditory canal. In health it disappears by evaporation 
or is forced out by the movement of the jaws. In adults, and less 
often in children, the wax accumulates in the ear and forms a hard 
plug. This is most likely to happen after water or soap has entered 
the ear or in persons engaged in greasy and dusty occupations. 
Picking the ears with pins sometimes causes slight inflammation 'of 
the skin with exfoliation of epithelium, which, mixing with the wax, 
forms a plug. The impacted wax causes deafness, but no other 
symptoms unless it presses against the eardrum, when it may produce 
pain, vertigo, vomiting, and general nervousness and irritability. 

Treatment .—The wax may be softened by dropping into the ear 
a few drops of a solution of glycerin and water, half an ounce of 
each, to which 20 grains of bicarbonate of soda have been added. 
After this has been used a day or two several drops of peroxide of 
hydrogen may be placed in the ear and the ear then washed out with 
warm water containing a teaspoonful of bicarbonate of soda to 
the pint. The stream should be thrown well into the opening of 
the canal, but without much force, as otherwise fainting may be 
produced or the eardrum injured. The washing out the ear canal 
is sometimes effective without the preliminary use of the ear drops. 




Fig. 132.—Gonococcus in urethral dis¬ 
charge. a, Free cocci in groups; b , 
the same inclosed in cells. 


Fig. 133.—Nurse visiting a reported 
case of sore eyes. 


Fig. 134.—This baby wasattended by a physician 
who neither reported the birth nor the inflamed 
eyes. The baby is blind for life. 

49071 °— 2 " - 14 


Fig. 135.—This baby’s sore eyes were reported 
and his sight saved by prompt medical and 
nursing care. 




\ 






















Fig. 136.—Inflamed band and arm following a small wound. (From 
Da Costa’s Surgery. Courtesy W. B. Saunders Co.) 



Fig. 137.—Different forms of pus producing bacteria. 
(From Richie’s Primer of Sanitation. Courtesy World 
Book Co.) 



Fig. 13S.— Forms of bacteria. (From Richie's Primer of 
Sanitation. Courtesy World Book Co.) 





















FIRST AID TO THE INJURED. 


By Surgeon M. H. Foster, 
United States Public Health Service. 


WOUNDS. 

DESCRIPTION. 

Injuries in which the skin has been opened, torn, or punctured 
are called wounds. There are many varieties of wounds. The most 
important kinds will be described later on. 

Severe wounds may inflict great damage to the muscles, bones, 
vessels, or internal organs, but in all wounds there is a secondary 
danger that severe inflammation may follow. The likelihood of 
inflammation exists in small wounds as well as large ones; hence 
all wounds must be handled carefully to avoid this complication, as 
even a trivial injury like the prick of a pin has been known to 
result in death from this cause. 

THE CAUSE OF INFLAMED WOUNDS. 

It is a matter of every-day experience that the countless little 
cuts and scratches which every person receives during a lifetime 
almost always heal without trouble, no matter whether treated or 
not. It is also w T ell known that occasionally these small injuries, 
and more often the larger ones, do not do well. The wound becomes 
red and painful, it throbs, the edges swell, and finally matter de¬ 
velops. This matter is called “ pus.” When the matter escapes the 
pain ceases and the cut gradually heals. At other times the redness 
rapidly spreads, the swelling increases, pain becomes worse, tender 
kernels form in the groin or armpit and in a short time the entire 
arm or leg, as the case may be, becomes involved (fig. 136). Taken 
at this stage, prompt and vigorous surgical treatment may produce 
a cure, but if neglected the condition steadily grows worse and 
sometimes ends in death. It was formerly believed by most people 
that these unfavorable terminations of small wounds were due to 
“ catching cold ” in the wound. It is now known that the inflam¬ 
mation of wounds is always due to the presence of bacteria or pus 
germs, as they are commonly called (fig. 137). 


181 



182 


PREVENTION OF DISEASE AND CARE OF SICK. 


DESCRIPTION OF GERMS. 

These germs or bacteria are the smallest of all living things. 
Even when magnified by a powerful microscope they are not the 
fierce-looking animals with eyes, teeth, legs, etc., which are fre¬ 
quently represented in the newspapers, but in reality plants of the 
simplest kind. These minute plants occur in various forms; some 
resemble balls, others rods, and a few are spiral in shape similar to 
a piece of broken corkscrew (fig. 138). Like all other plants, they 
require warmth, water, and food in order that they may grow and 
flourish. All bacteria can be killed by heat and certain powerful 
chemicals, such as tincture of iodine, carbolic acid, or bichloride of 
mercury. Germs are so exceedingly small that it is difficult to get 
a correct idea of their real size. Millions of them can float around 
in a drop of dirty water without touching. One writer gives a 
good idea of their relative size by stating that if one of them were 
placed alongside of a man and both were magnified sufficiently to 
make the bacteria about the sizt, of a period in a newspaper the 
man would appear as high as Mount Washington. These little 
parasites are found practically everywhere. They are on the walls 
and floors of dwellings, on our clothes, in our mouths, and on and 
in the outer layers of the skin. Water, except that from very deep 
wells, contains them, and they are very numerous in the upper layers 
of the soil. They are so small that they can not be felt or seen by 
ordinary means, but they are present on practical^ all objects just 
the same. It must not be understood that all bacteria will attack 
the human body or produce disease.. Some of them are actually 
beneficial to man, many of them are harmless, and only a few, 
when introduced into the system, will cause disease or set up inflam¬ 
mation. The latter kind, the dangerous bacteria, are often called 
germs. 

Bacteria multiply by the simple process of dividing into two. A 
groove forms around the germ; it gradually becomes deeper, finally 
cuts the germ into two parts, and in a short time there are two bac¬ 
teria where there was one before (fig. 140). Under favorable circum¬ 
stances this process of division may occur in as short a time as 20 
minutes. The two resulting bacteria also divide, and the multiplica¬ 
tion continues as long as the proper conditions of food, moisture, and 
temperature are present. One bacteria is capable in this way of pro¬ 
ducing 17,000,000 of descendants in 24 hours. It has been estimated 
that if all the bacteria in the world were placed under the most 
favorable conditions that in two days they would fill all the oceans 
and cover the earth 50 feet deep. Fortunately there are a great many 
things which hinder the development of microorganisms and no such 
invasion ever takes place. 



Fig. 139.— Showing how a pencil point would look if 
the bacteria were magnified and the pencil kept its 
original size. (From Richie's Primer of Sanitation. 
Courtesy World Book Co.) 



Fig. 140.—Method of division of bacteria. (From 
Richie’s Primer of Sanitation. Courtesy World 
Book Co.) 


Fig. 142.—Method of removing sterile 
dressing from container. 


Fig. 143.—Method of handling sterile 
gauze when dressing a wound. 















































Fig. 144.—Making a swab, and finished swabs. 



Fig. 145.—Wound of the forefinger, step one. Cleaning the hand and 

adjacent parts. 



Fig. 146.—Wound of the forefinger, step two. Painting the finger 
with half-strength tincture of iodine. 
















PREVENTION OF DISEASE AND CARE OF SICK. 183 

The skin is so constructed as to prevent the entrance of germs into 
the system as long as it is not broken or injured. The skin from this 
standpoint may be compared to the can in which canned meat is 
preserved. As long as the can is perfectly tight the meat keeps sweet, 
but if the can is opened or a hole punched in it the contents very 
quickly spoil and this putrefaction is due to the entrance of bacteria. 
The system possesses certain powers of resistance against the action 
of these little parasites, and ordinarily when a few are introduced 
they are promptly destroyed before they can do any damage. How¬ 
ever, when a large number gain access to the body, or when certain 
very powerful ones are introduced, or if the person is debilitated, they 
are sometimes able to multiply and set up a great deal of mischief. 

VARIETIES OF WOUNDS. 

1. Incised wounds .—When the skin or tissues are cleanly cut with 
a sharp instrument, such as a knife, razor, or piece of glass, the injury 
is called an incised wound. Wounds of this description bleed very 
freely, but are likely to heal quickly if properly treated and leave but 
slight scars. 

2. Lacerated wounds .—Lacerated wounds are caused by some blunt 
instrument which tears and bruises the flesh. A good example of a 
lacerated wound is the gash which may be torn in the arm of a 
butcher by a meat hook. The injuries caused by machinery, such as 
crushing the fingers in cogweels or crushing the foot under a car 
wheel, are lacerated wounds. Such injuries, as a general thing, do not 
bleed as freely as incised wounds, but there is great danger of in¬ 
flammation, because almost always bacteria are introduced into the 
wound and the torn and bruised tissue has very little power of re¬ 
sisting* them. Great care must therefore be used in handling and 
dressing these injuries. Lacerated wounds heal slowly and often 
leave extensive scars. 

3. Punctured wounds .—Punctured wounds are produced by nar¬ 
row sharp-pointed instruments such as nails, daggers, or bayonets. 
Bullet wounds are also included under this classification. The dan¬ 
ger from such wounds are twofold. Important internal organs may 
be injured and bacteria are likely to be carried deeply into the tissues 
where the conditions are very favorably for their growth. Such 
wounds are difficult to disinfect, and if pus develops it is apt to spread 
widely. A much dreaded result of punctured wounds is lockjaw or 
tetanus. This is especially apt to follow punctured wounds of the 
feet caused by stepping on a nail or the tooth of a rake. In modern 
warfare locklaw is sometimes a complication of gunshot wounds. 
(See Tetanus, p, 196.) 


184 


PREVENTION OF DISEASE AND CARE OF SICK. 


Symptoms of wounds .—The injury itself, pain, bleeding. After 
some wounds the patient may go into shock (p. 220.) 

GENERAL PRINCIPLES OF THE TREATMENT OF WOUNDS. 

From what has been said concerning the action of bacteria on 
wounds, it is evident that great care must be exercised in handling 
or dressing these injuries to prevent the introduction of living germs. 

INFECTED WOUNDS. 

A wound that contains bacteria is said to be an infected -wound. 
Attempts to destroy the bacteria in a wound is known as disinfecting 
it. Many wounds are infected at the time they are received, because 
the knife or other instrument has bacteria on it and these were left 
in the flesh (fig. 141). There are other sources of infecting open 

wounds such as the hands or instruments 
used in treating them and the dressings 
which are applied. As our hands and the 
ordinary materials like muslin or gauze 
which might be used for dressings always 
contain numerous germs, before han¬ 
dling or treating a wound it is necessary 
to take certain precautions to kill the 
bacteria on everything which is going to 
be used about the injury, and also to 
prepare or to use a specially prepared 
dressing. Even after these preparations 
have been made, great care must be exer¬ 
cised to see that the hands or dressing do 
not come in contact with some object 
which has not been so treated and new germs be thus picked up. 

Sterilization. —The best way to kill bacteria is with heat. All 
dressings, instruments, and other substances which are used in wound 
dressing are therefore first heated, generally bv boiling water or 
steam, and are then said to be sterile. The process of killing bacteria 
is known as sterilization. It is impracticable, of course, to steam 
the hands of the doctor or dresser, so special means must be used to 
free these of living germs before dressing or handling a wound, if it 
is possible to do so. 

Preparation or sterilization of the hands. —The hands should be 
thoroughly scrubbed for five minutes with a nail brush, hot water 
and soap. Then the fingernails should be cut short and the spaces 
under the nails thoroughly cleaned out, after which the hands and 
nails are again scrubbed for five minutes. After the second scrub¬ 
bing the hands should be rinsed in clean water and soaked for 



Fig. 141.—Bacteria being intro¬ 
duced into a wound on a 
needle. (From Richie’s Primer 
of Sanitation, Courtesy World 
Book Company.) 







PREVENTION OF DISEASE AND CARE OF SICK. 


185 


several minutes in a solution of one to two thousand of bichloride of 
mercury, a 3 per cent solution of compound cresol, or a mixture of 
2 parts of grain alcohol with 1 of water. These chemicals are used 
in order to kill the few germs which may have escaped the scrubbing 
process, but the thorough rubbing and soaking is of more impor¬ 
tance than the use of the special solutions. After preparing the 
hands in this manner they must not be wiped on an ordinary towel, 
even though it is clean, because the towel will probably contain bac¬ 
teria and undo to a certain extent the preceding processes. 

After the hands have been sterilized in the above manner great 
care must be taken not to touch any object which has not been 
previously boiled or steamed. An assistant should remove any 
bandages and the top dressings, and be at hand in order to give any 
assistance which will be required so that it will not be necessary for 
the operator to touch anything but the boiled instruments, sterile 
dressings, or the wound itself. 

On account of the nails and the various cracks and crevices around 
the hands it is very difficult to sterilize them completely by any 
process. Hence, in recent years surgeons have been wearing rubber 
gloves to a great extent when operating or dressing wounds. Such 
gloves can be boiled and rendered perfectly free from germs. It is 
always advisable, however, before putting on the gloves, to wash the 
hands as thoroughly as possibly, because during the operation the 
glove may be torn and bacteria introduced from the hands into the 
wound through the hole in the glove. 

Metallic objects, like instruments, basins, or pans, are sterilized 
by boiling in water for 10 or 20 minutes. The hot water should be 
poured off without touching the instruments and they should be 
allowed to remain in the pan and the pan carried to the bedside. If 
it becomes necessary to lay down the instrument, it should be placed 
in the pan again, and not on a table or similar place, as in this way 
it can be kept sterile. In doing home dressings, it is an excellent 
plan to place a little water in several clean agate basins or pans, put 
on the covers, and place them on the stove and allow to boil for 10 
minutes. The hot water can be thrown out and the inside of the 
pans will be sterile and afford a safe place in which to deposit sterile 
dressings or instruments while the wound is receiving attention. 

Sterile dressings .—Whenever possible, all dressings which are to 
be used on wounds should have been previously treated with heat so 
as to kill the bacteria. Materials prepared in this way are called 
sterile dressings. This means that there are no living bacteria on 
them. Usually sterilized dressings are carefully wrapped up in 
paraffined paper, sealed in jars, or otherwise protected so that they 
will remain free from germs as long as the covering is intact. After 
such a package has been opened and the contents handled, it is no 


1SG 


PREVENTION OF DISEASE AND CARE OF SICK. 


longer sterile "because a few bacteria will certainly be deposited on 
the dressing by such handling. Sterile gauze for dressings, prop¬ 
erly sealed in various size packages can be obtained at most drug 
stores. One firm at the present time is putting up such gauze in 
pieces half a yard square, and each piece separately sealed in a paraf¬ 
fined envelope. This method of preparing gauze is a very excellent 
one for home use, as there is no danger in infecting the rest of the 
supply when taking out a piece for a wound dressing. 

Prepared gauze impregnated with various medicinal substances 
such as bichloride of mercury, carbolic acid, etc., is often used on 
wounds. This is known as antiseptic gauze. 

Unless the hands have been carefully prepared previously, great 
care must be exercised in opening and handling sterile dressings. 
Such dressings should be taken out of the jar or package by touching 
them on one corner only (fig. 142). They should not be allowed to 
touch any other object before they are placed on the wound, and the 
dressing should be so applied that the part which has come in con¬ 
tact with the fingers does not come in direct opposition with the 
broken skin. 

When time is available and no regular sterilized dressings are at 
hand, ordinary muslin or similar material can be sterilized in the 
following manner: 

The muslin or gauze should be cut of sufficient size and properly 
folded to the correct size and shape so that it is all ready to be laid 
on the wound. Then it should be placed in a clean saucepan and a 
little water poured over it. The saucepan should be tightly covered 
and the dressing boiled for 20 minutes. The excess water should be 
poured off by inverting the saucepan and lifting the lid a little. Then 
the pan can be turned right side up again, the lid removed, and the 
dressing dried out in the oven, or with care on the top of the stove. 
It will do no harm if it is slightly scorched, but it should be dry 
and cool before being applied. Dressings can also be sterilized by 
baking them thoroughly in a hot oven. They should be placed in a 
pan so that the dressings can be removed from the oven without 
touching them directly. 

When regularly sterilized dressings are not available one should 
use material which is as free from germs as possible, such as freshly 
laundered handkerchiefs, old linen, towels, etc., which have not been 
used. The process of laundering and the heating and ironing will 
kill a great many of the microorganisms which are found on such 
materials, but. of course they are constantly collecting new bacteria 
on account of the handling which they must undergo. However, in 
an emergency such freshly laundered dressings are very much better 
than the soiled rags or cloths which are very often placed on wounds. 
Germicides and antiseptics ,—Chemicals which will kill bacteria. 



Fig. 147.— Wound or the forefinger, step three. Sterile dressing ap¬ 
plied to the finger. 



Fig. 148.—Method of removing boiled 
dressing from a pan. 



Fig. 149.—Method of sewing up a wound. 
(From Da Costa’s Surgery. Courtesy 
W. B. Saunders Co.) 






























Fig. 150.—Method of removing stitch. 



Fig. 151.—Wet dressing for inflamed wound of the hand. Note that 
the dressing extends to the armpit; also hot-water bottle, and pro¬ 
tection to the bed by oilcloth. 












PREVENTION OF DISEASE AND CARE OF SICK. 


187 


are called germicides. Tincture of iodine and carbolic acid are good 
germicides. The attempts to kill germs by heat or chemicals is 
known as disinfection. Certain substances, while they are not able to 
kill bacteria to any great extent, can prevent them from growing, 
and such chemicals are known as antiseptics. A solution of boric 
acid is a good illustration of an antiseptic. 

Boric acid .—Boric acid is a white powder which is extensively 
used in medicine. A saturated solution is made by stirring a heap¬ 
ing tablespoonful of the powder into a pint of hot water. This solu¬ 
tion is soothing and cooling to the tissues and is often used to irri¬ 
gate dirty wounds, to wash out the eyes, as a mouth wash, and also 
on compresses to apply to burns and inflamed wounds. Boric acid 
in solution is nonirritating to the tissues, prevents the development 
of bacteria, and is not poisonous. Boric-acid ointment is an excellent 
application for burns and abrasions. It is prepared according to the 
following formula. 

Boric acid in fine powder, 1 part; paraffin, 1 part; white petro¬ 
latum, 8 parts. Melt the paraffin, add the white petrolatum, and 
heat gently for 10 minutes. Then gradually add the hot liquid to the 
boric acid in a warm pan and stir the mixture thoroughly until it 
hardens. 

In an emergency a fair substitute can be improvised by thoroughly 
mixing 1 part of boric acid powder with 10 parts of vaseline or 
petroleum molle. 

DISINFECTION OF WOUNDS. 

It was formerly the custom to attempt to destroy any bacteria 
which might have gotten into a wound at the time of the accident by 
washing the injury with solutions of carbolic acid, bichloride of 
mercury, hydrogen peroxide, or similar substances. It has been 
demonstrated, however, that it is practically impossible to kill all 
the germs in this way and that if the solutions are of sufficient 
strength to kill the germs that they will do harm to the tissues. In 
first-aid work wounds therefore should not be irrigated with such 
solutions unless they are very badly soiled with dirt or if it is 
necessary to wash out a number of small foreign particles. If the 
wound is reasonably clean it is much better to simply apply tincture 
of iodine. This is done by taking a clean match or toothpick, twist¬ 
ing a small amount of cotton around the end to make a swab (fig. 144), 
dipping the swab in the iodine, and applying a light coat first to the 
wound and then to the surrounding skin. The iodine will destroy 
most of the germs and do no harm to the tissues. Experience has 
shown that in first-aid work wounds which have been treated with 
iodine in this way do better than those which have been washed out 
with watery solutions. If the skin of the hand, foot, or part which 


188 PREVENTION OF DISEASE AND CARE OF SICK. 

happens to be injured is very dirty, it is permissible to dampen a 
cloth slightly with soap and water or gasoline and to wipe off as 
much of the dirt as possible from the skin some distance away from 
the wound, being careful, however, to avoid touching the wound 
itself or the area immediately adjoining it. Under no circumstances 
should ordinary water be put into a wound, nor should the cleansing 
cloth be sufficiently wet to permit the chance of any of the cleansing 
fluid running into the wound. After the tincture of iodine has been 
applied the wound should be dressed and the dressing held in place 
with a bandage or other appliance. 

Tincture of iodine is sometimes used just as it comes from the drug 
store, but it is very much better to dilute it. When buying tincture 
of iodine for application on wounds it is advisable to always have 
the druggist add an equal amount of grain alcohol to the regular 
preparation, making a half-strength tincture. This diluted solu¬ 
tion is very efficient for killing bacteria and is not so likely to irritate 
the skin as the full strength. The weaker solution should be always 
used for applying to wounds when available. It is also wise to allow 
the alcohol to evaporate for a few moments before applying the 
permanent dressing. 

Wet dressings should not be placed on skin which has been re¬ 
cently painted with tincture of iodine, as irritation is likely to result. 
Iodine may be removed by washing with alcohol. The irritating 
action of too much iodine on the skin can be checked by applying 
thin, cooked starch paste. 

WOUNDS WHICH ARE SOILED WITH DIRT, SAND, OR FOREIGN 

BODIES. 

Reference has already been made to the fact that it is undesirable 

to wash wounds out with solutions unless absolutelv necessary. When 

«/ */ 

dirt and other substances have gotten into the injury, however, it is 
necessary to remove them and we must take the lesser of two evils and 
apply solutions. Large particles of dirt may be picked out with a 
forceps which has been boiled, or with the fingers which have been 
specially washed and sterilized as described on page 181. 

In an emergency, if it is necessary to place the hands in the wound 
without washing, they should be covered with several thicknesses of 
sterile gauze as this will assist in preventing infection of the wound. 
After picking out the gross particles the dirt may be removed by 
flushing the wound with a suitable solution and scrubbing with pieces 
of sterile gauze. For this purpose use freshly boiled and cooled boric- 
acid solution made by stirring a heaping tablespoonful of powdered 
boric acid into a pint of hot water, or a 1 to 5,000 bichloride of mer¬ 
cury solution, or a 3 per cent compound cresol solution. Pieces of 
gauze may be boiled in the solution and used as swabs. These solu- 


PREVENTION OF DISEASE AND CARE OF SICK. 


189 


tions should be poured into the wound from the pan in which they 
have been prepared. If dry sterile gauze is available the interior of 
the wound should be dried as well as possible after the dirt has been 
removed. It is well to allow it to remain exposed to the air for a 
short period to further the drying process. Be careful about disturb¬ 
ing blood clots in wounds because this may start bleeding afresh. 

HYDROGEN PEROXIDE. 

The practice of applying hydrogen peroxide to fresh wounds is 
not recommended as a routine practice. It causes a great deal of 
pain, wets the wound, and is not an efficient germicide. Hydrogen 
peroxide may be used sometimes to check hemorrhage or to clean up 
an old leg ulcer, hut it should not be applied to other wounds except 
on advice of a physician. 

DRESSING AND TREATMENT OF WOUNDS. 

As soon as a wound has been received the first procedure is to deter¬ 
mine whether it will be necessary to take active steps to check hemor¬ 
rhage (p. 205). The clothing should be removed or rolled out of the 
way so as to give a good view of the injury. In the great majority 
of cases the bleeding will be slight and will cease spontaneously in 
a few moments. If the wound is more than a slight cut, a doctor 
should be summoned. Pending the arrival of the physician, the 
wound is left alone, nothing being done except to keep the patient 
still unless it is necessary to check hemorrhage. The patient should 
rest in a comfortable position and be kept quiet so that the clothing 
does not rub over the injury, thus introducing bacteria. The wound 
may be freely exposed to the air without risk for an hour or two, pro¬ 
vided nothing is allowed to touch it. 

If it will be a long time before medical help arrives, the wound 
should be covered with several thicknesses of sterile gauze or as clean 
material as can be obtained in order to protect it from accidental con¬ 
tact with the clothing or other objects. If the patient has to be taken 
a considerable distance, a regular dressing should be applied and fas¬ 
tened in place with a suitable bandage. 

Dressing of wounds .—The best dressing for a wound is sterile 
gauze. Four or more thicknesses of the gauze should be used, depend¬ 
ing upon the extent of the injury and the amount of oozing. The 
gauze should be folded into such a shape as to cover the wound com¬ 
pletely and extend for some distance over the sides. It is much better 
to have the dressing too large than too small. The purpose of the 
dressing is to protect the wound and to keep out germs. In large 
wounds a layer of sterile absorbent cotton is generally placed over 
the gauze. This can be omitted in small wounds. 


190 


PREVENTION OF DISEASE AND CARE OF SICK. 


Never put cotton directly next to a wound. The blood and dis¬ 
charges will harden in the cotton and cement it fast so that the wound 
may be torn open when it is necessary to remove the covering. 

The dressing must be held in place by some method, and this is gen¬ 
erally done by a bandage. The bandage need not be sterile if the 
wound has been properly dressed. For instructions concerning 
bandages and their application see page 222. The dressing on an 
ordinary wound should be left on for at least four or five days, if it 
feels comfortable and no pain or throbbing develops in the injury. 
If the bandage becomes loose, it should be replaced without disturb¬ 
ing the dressing. If pain develops in the wound and it begins to 
throb, the dressing should be removed and the wound examined. 
It has probably become inflamed and will require special treatment. 
For the treatment of inflamed wounds see page 191. 

FIRST-AID PACKETS. 

Small packages properly sealed and protected containing sterile ma¬ 
terials for dressing a wound are carried by all soldiers and are often 
kept on hand for emergencies in factories, on trains, etc. Various kinds 
of first-aid packets are on the market, but an excellent one is supplied 
by the American Red Cross. The American Red Cross Textbook on 
First Aid describes the Red Cross first-aid outfit as folloAvs: 

In each of these outfits is found a long gauze bandage, with a compress of 
gauze sewn to it in the center, a triangular bandage printed so as to show how 
to apply it, and two safety pins. 

The directions, which are also found inside the case, are as follows: 

‘‘Gauze bandage with compress. —If there is a wound or any injury in which 
the skin is broken, this bandage and compress are used by unfolding the bandage, 
being careful not to touch the inner surface of the compress. The compress 
should then be placed directly on the wound or injury, and held in place by 
wrapping the ends of the bandage around the limb in opposite directions and 
tying them or pinning them in place. With a very large wound which the 
compress will not cover, apply it to the middle of the wound and wrap the 
bandage around as before. In this case be careful not to touch any surface 
of the bandage which is placed on the wound. In case there is no wound, this 
bandage may be used like an ordinary bandage to hold splints in place, etc.” 

Such packets are useful for soldiers and travelers, but every home 
should contain at least a small supply of sterile materials suitable 
for dressing burns and cuts. The following are suggested as most 
important: 

Five yards of sterile gauze, in half yard packets, if obtainable. 

One-fourth pound of sterile cotton. 

One dozen assorted sterile gauze bandages—from 1 inch to 3 inches. 

One-fourth pound of vaseline. Petroleum molle is just as good and 
generally much cheaper. 

One ounce of tincture of iodine (half strength) in a glass-stop¬ 
pered bottle. 

One-fourth pound of boric acid. 


PREVENTION OF DISEASE AND CARE OF SICK. 


191 


FURTHER TREATMENT OF WOUNDS. 

Small cuts. —Bleeding is beneficial as it serves to wash out bac¬ 
teria. After hemorrhage has ceased, paint the wound and the sur¬ 
rounding skin for considerable distance with a light coat of iodine 
as above described. Apply a dressing of sterile gauze or freshly 
laundered muslin and hold in place with a bandage. A sterile gauze 
bandage makes a convenient dressing for small injuries around the 
fin gers or hand. A piece of the bandage may be folded into a com¬ 
press, or the bandage alone simply wrapped around the finger, care 
being exercised'so that the part which goes next-to the wound is 
iiot fouched-bv the operator. . . 

Large*cuts— These are;apt to bleed freely, but unless an artery 
or large vein has been opened, the hemorrhage will in most cases 
cease of itself. 

"* - * ~ j ' \ ' T- t\ '■ ’• n J 4 --» 

First-aid treatment.— Send for a doctor. If the. blood comes in 
spurts appjy a tourniquet. For the treatment of hemorrhage, see 
pageC205. “While waiting for the physician make the patient com¬ 
fortable and see that the clothing does not come in contact with the 
wound. If the patient has to be transported before medical help 
can be obtained, cover the wound with a number of thicknesses of 
sterile gauze, boiled dry muslin, or similar material. If these are 
unobtainable, use some freshly laundered article such as a clean- 
handkerchief, towel, or napkin. Hold the dressings in place with a 
bandage. 

“ « ^ , r « . * 

Treatment when no doctor will be available .—After bleeding has 

ceased, apply a light coat of tincture of iodine to the wound and sur¬ 
rounding skin with a cotton swab. Dress with sterile gauze or simi- 

® - r. 

lar material as directed above. 

In an ordinary wound no effort should be made to remove the 
clotted blood from the wound and the skin immediately around it. 
The blood is aseptic and when dry makes an excellent protection for 
the tissues. The dressing should be applied over this material with- 

out disturbing it. . , . ' 

LACERATED WOUNDS. : 

. « * f ’ 

Most of these wounds are infected with bacteria at the time the 
injury is received, but severe bleeding is rare.,; 

First-aid treatment .—Check hemorrhage if necessary. Send for a 
doctor. Cover the wound with a sterile dressing making no attempt 
to disinfect it. While awaiting the arrival of the physician, make 
the patient as comfortable as possible and treat shock, if it is present 
(p. 2*20). If no sterile dressing is available, leave the part ex¬ 
posed to the air but take care that nothing touches the wound. 
Treat crushes of the hand, arm, foot, or leg in the same manner. 

411671 °—- 15 + 16 



192 


PREVENTION OF DISEASE AND CARE OF SICK. 


If the patient has to be transported, wrap the part in sterile gauze 
or other sterile material, hold the dressing in place with a bandage, 
and place the injured member on a pillow. Do not attempt to move 
the patient until the symptoms of shock have disappeared. 

After treatment .—Small lacerated wounds may be given a light 
coat of tincture of iodine and also the skin for a considerable area 
around them. Then apply a dressing of sterile gauze. It is not nec¬ 
essary to put any medicinal substance on fresh wounds to make them 
heal. If bacteria are kept out of the injuries, they will heal quickly 
enough. 

Large lacerated wounds are treated according to the general prin¬ 
ciples which have been laid down. 

Foreign bodies are removed by a boiled forceps or the fingers after 
„ special preparation of the hands. If much dirt has been ground into 
the tissues, it will be necessary to wash the wound out with freshly 
boiled boric-acid solution (p. 188), 1 to 5,000 bichloride of mercury 
solution, or boiled salt solution made by adding a teaspoonful of salt 
to each quart of water. After cleansing the wound, dry it if dry 
sterile gauze is available and apply a dry sterile dressing and hold 
the dressing in place with a suitable bandage. 

Crushes of the extremities are laid on a pillow. The part is gently 
molded in its natural shape. Small wounds are painted with tincture 
of iodine. Large dirty wounds are cleaned out with antiseptic solu¬ 
tions. The wounds are dressed. After swelling has subsided, suit¬ 
able splints are applied if fractures are present. 

Lacerated wounds in which the tissues have been badly or exten¬ 
sively damaged are almost certain to become inflamed. When in- 
flamtation sets in, treat according to the general rules for inflamed 
wounds (p. 194). 

The Carrel-Dakin solution .—Many of the severely lacerated 
wounds, due to shell injuries in modem warfare, have been recently 
successfully treated by intermittent irrigation with a mild antiseptic 
fluid called the Carrel-Dakin solution. 

The skin around the injury is protected with vaseline and a num¬ 
ber of perforated rubber tubes attached to a reservoir are inserted 
to the bottom of the wound so that the fluid will reach all parts of 
the injury. The tubes in the wound are loosely surrounded with 
gauze. Sufficient of the solution is run through the tubes every two 
hours to wet the gauze thoroughly, but no more. This method lias 
given excellent results in trained hands, but its proper application 
is too complicated for the layman. 

Dakin has recently suggested the use of dichloramin-T in solutions 
of chlorinated oil to obviate some of the difficulties of the Carrel 
method. The use of this remedy is simple, as the oily fluid is merely 
sprayed once a day onto the wound with an atomizer and then a fresh 


PREVENTION OF DISEASE AND CARE OF SICK. 


193 


dressing applied. Some very favorable reports have been already 
made on treating wounds with this solution. It is hoped that they 
will be verified by more extended research, as its simplicity would 
highly recommend it for use by the layman in emergencies. 

PUNCTURED WOUNDS. 

As has already been stated, punctured wounds are especially dan¬ 
gerous because bacteria may be carried deeply into the tissues where 
conditions are very suitable for their growth. Lockjaw not infre¬ 
quently developes from such injuries. Always examine the article 
which inflicted the injury to determine if the end may have been 
broken off in the wound. 

Treatment .—An effort should be made to disinfect the wound with 
tincture of iodine. Take a toothpick and twist a small amount of 
cotton around one end. Dip it in the iodine. Then push it down to 
the bottom of the wound and work the iodine thoroughly into the 
tissues. Paint the surface with tincture of iodine and apply a sterile 
dressing. All these patients should be taken to a doctor to have him 
determine whether injections of antitetanic serum are necessary to 
prevent lockjaw. (See Tetanus, p. 196.) 

SEWING UP A WOUND. 

The layman should never attempt to sew up a wound if a physician 
is within reach. However, on shipboard or in other isolated places, 
it may be absolutely necessary for an untrained person to attempt 
this operation if the wound is large or gaps freely. It is better not 
to sew up a very deep wound unless it is long and the edges gap 
very widely. The edges of a great many large wounds can be brought 
together and held m place by suitable compresses and bandages. In 
sewing up a wound all the instruments, needles, thread, etc., should 
be. boiled immediately before the operation. Prepare several stout 
needles, a pair of scissors, a probe or a hairpin, and a thimble, also 
an extra pan or basin in which to place sterile dressings or other in¬ 
struments if occasion arises. Take heavy thread which will go 
through the eyes of the needles and cut it in lengths about 12 inches 
long. All these materials, as has been said before, are boiled and 
left in the pan m which they have been prepared. The hands are 
carefully sterilized as described on page 184. The wound, if clean, 
is swabbed with tincture of iodine, also the surrounding skin. If the 
wound is dirty it is cleaned out with boric acid solution or bichloride 
of mercury, 1 to 5,000, as previously described. The threaded needle 
is inserted into the flesh about one-quarter of an inch from the edge 
of the wound and pushed through so that it emerges at the bottom, 
including a good bite of the tissues in its course. It is then rein¬ 
serted in the bottom of the wound and made to emerge on the oppo- 


194 


PREVENTION OF DISEASE AND CARE OF SICK. 


site side about one-quarter of an inch from the edge of the incision. 
The thread is cut off leaving enough material so that it can be tied. 
The stitches are placed about one-half an inch apart and are tied 
with just sufficient tension to bring the edges of the wound together 
and yet not exert pressure (fig. 149). Use too few stitches rather than 
too many. After tying, the ends are cut off leaving about one-half 
an inch from the knot. If the edges of the skin tend to turn in when 
the stitches are being tied the}^ should be lifted up and placed in 
proper position with the probe or hairpin. It is necessary for the 
raw edges to be accurately approximated if good healing is to be 
secured without a scar. If the wound has been lacerated o:; has con¬ 
tained dirt, make a wick by twisting 10 or more strands of thread, 
depending upon the size of the injury, lightly together, and lay it 
in the bottom of the wound at the lower end, allowing about an inch 
of the wick to extend over the side in order to provide drainage. 
This wick is removed on the second day if no symptoms of inflam¬ 
mation have appeared. 

The thread used for sewing wounds may be either cotton, silk, or 
linen. Considerable difficulty may be experienced in pushing the 
needle through the skin, which is quite tough, and a thimble will be 
of material assistance in this part of the operation. After sewing 
up a wound it is well to paint it and the surrounding skin for a wide 
area with a coat of tincture of iodine, half strength. 

Remove the stitches at the end of five days. Use boiled instru¬ 
ments and sterile hands when removing the stitches. Cut the stitch 
on one side of the knot, and remove by pulling on the knot end 
(fig. 150). 

INFLAMED WOUNDS. 

Symptoms .—Sometimes after a wound has been received and 
dressed all goes well for a day or two and then the wound becomes 
painful and begins to throb. If the wound is extensive, the patient 
has fever, the tongue is coated, and there is headache, nausea, and 
loss of appetite. This condition is known as surgical fever and is 
due to the absorption of the poisons which are produced in the wound 
by the pus-producing bacteria. In such cases a physician should be 
called at once. If no physician is available the dressing should be 
removed and the wound inspected. The edges will probably be 
swollen, dry, and stuck together and there will be a diffuse redness of 
the skin surrounding the injury. It will be necessary to open the 
wound sufficiently to allow the matter which is forming within to 
escape. This can be done by boiling a probe, a hair pin, or some small 
blunt instrument, and then gently inserting it between the edges of the 
w T ound and opening them slightly. If the edges are not stuck to¬ 
gether and fluid is escaping from the wound, do not attempt to open 


PREVENTTOX OF DISEASE AXD CARE OF SICK. 


195 

it any more. Wet dressings should now be applied. These should 
consist of from 4 to 12 layers of gauze, depending upon the size of 
the injury, which are wet in a freshly prepared boiled solution of 
boric acid. Make the solution by boiling a pint of water in a clean 
saucepan and then stirring into it a heaping tablespoonful of boric- 
acid powder. Stir it until it dissolves and permit it to cool. Wet the 
gauze in this solution and lay it on the wound. Cover the dressing 
with a piece of oiled paper and renew the solution every four hours. 
A wet dressing should be thick and large enough to cover a consid¬ 
erable area around the injury. It should be kept wet by pouring a 
little more of the boric-acid solution under the oiled paper every 
three or four hours, day and night, if the symptoms are serious. 

Further treatment .—In a great majority of inflamed wounds as 
soon as the matter begins to escape freely from the wound the signs 
of inflammation gradually subside. Such, wounds should be washed 
out at least once a day with a freshly boiled and cooled solution of 
boric acid as above described, or a 1 to 5,000 solution of bichloride 
of mercury, or if these are unavailable, a solution made of one tea¬ 
spoonful of common salt to a pint of boiled water. Wet dressings 
should be continued for four or five days. After the pus begins to 
flow freely care should be taken that the edges of the wound do not 
grow together too soon, which will dam up the pus and cause the 
wound to become inflamed again. To insure the wound keeping open 
the edges should be gently separated every day with a probe or hair 
pin which has been boiled. The dressing should he changed as fre¬ 
quently as they become soiled with the escaping matter. Wounds 
which are discharging pus freely are known as suppurating wounds. 
Such wounds at times refuse to heal and become indolent. Indolent 
wounds may be irrigated with a solution made by adding enough tinc¬ 
ture of iodine to boiled water to make it a port-wine color. 

Inflamed wound of the hand .—It sometimes happens that slight 
injuries of the fingers or hands are followed by signs of rapidly 
spreading inflammation. The injured finger swells first, then the 
hand and forearm; the skin is red; painful kernels form under the 
armpit; red lines may extend up the arm; and the patient feels fever¬ 
ish and sick. There is also pain and throbbing in the part. The 
treatment for such cases is to open the wound freely with a sterile 
knife or probe and to wrap the whole hand and arm with several 
thicknesses of turldsh toweling which has been wet in the boric-acid 
solution above referred to (fig. 151). The addition of one part of 
alcohol to four parts of the solution is helpful. In the absence of boric 
acid use plain water, adding 20 per cent of alcohol, if it is available. 
Put the patient in bed, lay the arm on a pillow, keeping the dressing 
constantly wet day and night, and keep it warm by surrounding it with 
hot-water bottles. In such cases every possible effort should be made 


.196 PREVENTION OF DISEASE AND CARE OF SICK. 

to obtain a doctor at once, for the condition is very serious and may 
terminate fatally unless promptly controlled. Continue this treat¬ 
ment until the symptoms subside or medical help is obtained. 

In the meantime the patient’s strength should be supported by a 
light and nutritious diet, giving eggs and milk freely if they are 
obtainable. At the onset of the symptoms a purgative should be ad¬ 
ministered and the bowels should be kept open daily during the at¬ 
tack. Eest of the part is extremely important when inflammation 
starts in a wound. If the finger or hand is involved, put the arm in 
a sling. If the arm is affected, put the patient in bed and lay the 
arm on a pillow. Eest in bed is required if the wound is in the foot 
or any part of the lower extremity. Never dress a ‘wound with com¬ 
presses wet with a solution of carbolic acid , as gangrene is apt to 
follow. 

INFLAMED LEG ULCERS. 

Treatment. —If a leg ulcer becomes inflamed the patient should be 
put in bed and the foot elevated. Wet compresses of boric-acid solu¬ 
tion or of salt solution, made by adding a teaspoonful of salt to a pint 
of water, should be applied for three or four days until the inflamma¬ 
tion subsides. Then the ulcer may be dressed with oxide of zinc oint¬ 
ment or boric acid ointment. Eest in bed with elevation of the leg 
is very beneficial in the treatment of all leg ulcers. 

TETANUS OR LOCKJAW. 

r 

Description. —Tetanus is a dangerous disease due to a particular 
kind of a germ which is introduced into the body by some sort of an 
injury, frequently a slight wound. 

Symptoms .—The symptoms of tetanus are varied, but one of the 
most characteristic points is a stiffness of the neck and the lower 
jaw. Later on spasms of other parts of the body develop. The 
disease is extremely fatal, the mortality ranging somewhere between 
50 and 85 per cent. The germ which causes tetanus (fig. 152) is 
found especially in garden soil, in street dirt, and the dust around 
stables. It can not grow in the presence of air, hence lockjaw is apt 
to develop after deep punctured wounds, especially those due to nails 
or farming implements, and also in lacerated wounds into which 
street dust or soil has been forcibly ground. Tetanus has alwa}^s 
been prevalent among the wounded in armies, but especially so in the 
early part of the recent European war. This was probably due to 
the fact that the troops were fighting in trenches and soil and dirt, 
or pieces of soiled clothing were frequently forced into their wounds. 
Tetanus often follows Fourth of July injuries, especially wounds 
from toy pistols. A large number of cases were formerly reported 
every year in the United States after the celebration of the Fourth. 




Fig. 152. —Bacilli which cause lockjaw. 
(From Richie’s Frimer of Sanitation. 
Courtesy World Book Co.) 


Fig. 153.—Sewing up a scalp wound. 
(FromMumford’s Surgery. Courtesy 
W. B. Saunders Co.) 



Fig. 154 —Tourniquet for a snake bite. The band near the 
wrist is the tourniquet. The upper band holds the lever 
in place. 


Fig. 155. 


Showin 

a 


g how much space should be left in tying 
knot for a tourniquet. 



































Fig. 15G. —Dog with rabies. Dumb rallies. 
First day. Dropping of jaw. Drooling. 
Eyes glassy and apprehensive. (U. S. Pub¬ 
lic Health Service.) 



Fig. 157.—Dog with rabies. Dumb rabies. 
Second day. Paralysis of lower jaw. Drool¬ 
ing. Dull, depressed, and awkward. ((J. S. 
Public Health Service.) 



Fig. 158.—Dog with rabies. Dumb rabies. 
Fourth day. Jaw paralysis. Drooling. Com¬ 
plete posterior paralysis. (U. S. Public Health 
Service.) 



Fig. 160.—Arteries, capillaries, and veins. (From Richie’s Physiology. 

Courtesy World Book Co.). 























PREVENTION OF DISEASE AND CARE OF SICK. 


197 


Since the introduction of the injection of antitetanic serum after these 
accidents, the amount of tetanus from this source has greatly de¬ 
creased. It has also been almost eliminated among the European 
troops by the same procedure. Horse blankets or other articles which 
have been used around stables should never be allowed to come in con¬ 
tact with an open wound or a burned surface of the skin. 

Treatment .—When ^ person has received a lacerated wound which 
has been much soiled by dust or dirt, or a punctured wound from a 
nail or garden implement, the most important thing is Jto take the 
patient to a doctor and have him receive injections of antitetanic 
serum. This injection should be repeated at intervals of a week, 
until three doses have been given. The local treatment of punctured 
and lacerated wounds has alreadv been described. Tetanus usuallv 
develops in from 6 to 16 days after the receipt of the injury, but 
occasionally may not appear for as long a period as three months. 
Gunshot wounds in which pieces of clothing have been carried into 
the flesh are apt to be followed by tetanus. 

If tetanus does develop on board ship or in some other locality where 
a doctor can not be obtained, the patient should be placed in a darkened 
and quiet room. The bowels may be kept open by administering 
salts or castor oil daily. Give 20 grains of bromide of potassium 
with 10 grains of chloral every theree hours if necessary to produce 
quiet and allay pain. If attempts to swallow produce convulsions, 
the patient may be fed by small injections of beaten-up raw egg or 
other concentrated food by the rectum. 


SPECIAL WOUNDS. 

ABRASIONS. 

Abrasions are very superficial wounds in which the outer layers 
of the skin have been rubbed or ground off by dragging the part 
forcibly over some rough surface. 

Symptoms .—Pain and redness. The affected areas are “ raw " 
looking, and tiny drops of blood or serum may appear. 

Treatment .—If dirt has been ground into the injury it should be 
washed off with boric acid solution. If the surface is clean this is 
not necessary. A coat of diluted tincture of iodine, half strength 
or less may be applied, but ordinarily this is not necessary, and it is 
always very painful. Finally, dress with sterile gauze spread with 

boric acid ointment or oxide of zinc ointment. 

✓ 

BRUSH BURN. 


When a rope slides through the closed hands very rapidly a com¬ 
bination of an abrasion and laceration is produced known as a brush 

bum 


198 


PREVENTION OF DISEASE AND CARE OF SICK. 


Treatment .—Apply sterile compresses of boric acid solution for 
several days. Then dress with sterile gauze spread with boric ac id 
ointment. 

SPLINTERS. 

Small splinters may be removed from the flesh by means of a 
needle which has been passed once or twice through a flame and 
then cooled. Larger splinters may be extracted by passing a knife 
blade several times through a flame, cooling it, inserting the blade 
under the splinter and grasping the foreign body between the thumb 
nail and the knife. 

WOUNDS CAUSED BY FISHHOOKS. 

When the barbed end of a fishhook has entered the flesh, do not 
attempt to remove it by pulling if directly out. Such a procedure 
will cause great laceration and tearing of the tissues. The better 
plan is to depress the shank of the hook, push the point forward 
and onward in an upward direction, and bring it out on the surface 
at another point. The barbed end is then cut off with a wire cutter 
or file. The barbed end having been removed, the hook can be 
extracted by pulling on the shank without damage to the tissues. 

BULLET WOUNDS. 

Bullets make small, deep wounds which are generally classified as 
punctured wounds. 

First-aid treatment .—Send for a doctor. If sterile gauze is avail¬ 
able, cover the wound with that. Remember that there may be two 
wounds, one where the bullet went in, the other where it came out. 
If only one opening is seen, search for the other on the opposite 
side of the limb or body. Treat shock, if present. 

After treatment— If pieces of clothing have been carried into the 
wound and can be readily seen, remove them with a sterile instru¬ 
ment. Do not probe for the bullet. Swab the wound or wounds 
and surrounding skin with tincture of iodine and then apply a 
dressing of sterile gauze or other sterile material. Keep the injured 
part at rest. 

If a bone has been broken by the ball, treat as a compound 
fracture. 

As soon as possible take patient to doctor for injections of anti- 
tetanic serum. All persons injured by firearms should receive these 
injections. 

PERFORATING! WOUNDS OF THE CHEST. 

Perforating wounds of the chest are severe injuries and are often 
followed by grave consequences, the lungs, heart, or large blood ves¬ 
sels often being damaged. 


PREVENTION OF DISEASE AND CARE OF SICK. 


199 


Symptoms .— r J he wound itself, pain, hemorrhage, and sometimes 
the entrance and exit of air into the chest which can be detected by a 
peculiar whistling sound heard at the wound during the act of 
breathing. The patient may spit up blood, and shock is almost 
always present. 

First-aid treatment. —Send for a doctor immediately. Place the 
patient in a semire'clining position and treat shock if present. Cover 
the wound with a large pad of sterile gauze. 

After treatment. —Put the patient in bed; paint the wound with 
tincture of iodine; dress with a large compress of sterile gauze; place 
a tight bandage around the chest; and keep the patient quiet. Great 
swelling of the chest, neck, and even the face may occur, due to the 
entrance of air into the tissues, but in favorable cases this will sub¬ 
side spontaneously. 

SCALP WOUNDS. 

Scalp wounds are common and often result from a blow on the 
nead with a blunt object, such as a club or a beer bottle, the yielding 
scalp being caught between the rigid skull and the hard weapon. 

First-aid treatment. —Check hemorrhage, if necessary, by laying 
a compress of sterile gauze on the wound and fastening it tightly with 
a bandage around the head. In severe cases a tourniquet may be 
tied around the forehead and head just above the ears. Send for a 
doctor. Treat shock if present. 

After treatment. —Trim the hair close to the scalp for a wide area, 
around the wound. Be very careful that the cut hair does not get 
into the wound. Paint the wound and surrounding scalp with tinc¬ 
ture of iodine. Dress with dry sterile gauze. If the patient keeps 
disarranging the dressing by tossing the head during sleep, make a 
muslin cap with strings to tie under the chin. Hold the dressing in 
place by pinning it to the cap. 

If the wound is large and gaps widely, it may be necessary to sew 
it up. If a doctor is not available and the bleeding can not be con¬ 
trolled by a compress with firm pressure, sewing up the wound will 
stop it. In sewing up a scalp wound be guided by the directions 
on page 193. Insert the needle to the bottom of the wound and tie the 
stitches tightly enough to check the bleeding but no tighter than 
necessary (fig. 153). Always leave a small drainage wick made of 
about eight strands of boiled thread in one end of the wound. Bemove 
the drain in 48 hours. Take out the stitches in five days, and sooner 
if inflammation sets in. 

WOUNDS OF THE ABDOMEN. 

Shallow wounds of the abdomen are handled like similar injuries 
in other parts of the body, but deep wounds with escape of the bowels 
are very serious injuries and require special treatment. 


200 


PREVENTION OF DISEASE AND CARE OF SICK. 


First-aid treatment of wounds of the abdomen with escape of the 

bowels .—Send for a doctor at once. The bowels should be covered 
with several thicknesses of sterile gauze wet in boiled and cooled warm 
salt solution (a teaspoonful of salt to the quart of water). If no 
sterile gauze is at hand, boil a towel in a salt solution of the above 
strength, cool it until it is at body temperature, and then lay it over 
the intestines. Treat shock, which is certain to develop. 

After treatment .—When no doctor will be available proceed as 
follows: Lay the patient on his back. If the wound is in the lower 
part of the abdomen, raise the hips. Make every effort to avoid 
getting bacteria on the bowels or into the wound. Sterilize the hands 
(p. 184). Sterilize some salt soution and cool it to body temperature. 
Wash the bowel with this. Examine the bowel carefully to see if it 
has been opened and the contents escaping. If it is apparently 
sound, endeavor to gently return it into the abdomen, using the hand 
covered with sterile gauze for this purpose. Push the part which 
came out last back first. Gradually in this way work the bowel 
back into the belly. 

If the bowel has been opened, leave it on the outside, but dress 
with sterile gauze wet with salt solution. 

POISONED WOUNDS. 

Description .—These are wounds into which poison lias been injected 
at the time the injury was received. Snake bites and bee stings are 
examples of poisoned wounds. 

SNAJ£E BITES. 

(After Da Costa.) 

Description .—The bites of copperheads, water moccasins, coral 
snakes, and rattlesnakes are all poisonous. The diamond black rat¬ 
tlesnake is the most dangerous serpent of the United States. The bite 
from a small snake is not as poisonous as one inflicted by a large 
snake of the same species. The greater number of snake bites are 
received on the extremities. The poison fangs of snakes consist of 
hollow teeth which connect with the poison sac in the upper jaw. 
When the reptile strikes the teeth are inserted into the flesh, the 
poison sac is contracted, and the venom forced into the wound. 
There are two poison fangs, one on each side of the upper jaw. In 
snakes of the viper species the poison teeth lie along the back of the 
mouth and are dropped into a vertical position when the animal is 
ready to attack. Snake venom is a thin greenish-yellow fluid of 
characteristic odor and extremely poisonous. The mortality from 
bites of poisonous snakes varies, ranging from 5 per cent in the case 
of copperheads to about 20 per cent for the large rattlesnakes. 


PREVENTION OF DISEASE AND CARE OF SICK. 


201 


Symptoms .—Intense pain, discolored swelling of the bitten part, 
■which soon becomes very marked, and profound disturbance of the 
system. The general symptoms develop soon after the bite. They 
consist of great weakness and prostration, nausea, and a profuse 
How. of saliva. Paralysis of the muscles occur in from three to four 
hours. Unconsciousness is rare, but the patient falls into a kind of 
stupor. 

Treatment .-.-The bite is usually on the lower part of the limb, and 
a band made of a handkerchief, necktie, or similar article should be 
instantly applied a few inches above the wound between it and the 
heart and tightly twisted with a stick (fig. 154) to shut off the circu¬ 
lation to the part and prevent the poison from being carried into the 
svstem by the circulating blood. The bites of most venomous ser- 
pents consists of but two punctures. These small wounds should be 
freely incised with a knife and then sucked. There is no danger in 
sucking the wound if there are no cracks or sores in the mouth or on 
the tongue. After the wound has been sucked it should be cauterized. 
This is done by applying carbolic acid or nitric acid on the end of a 
stick, such as a match stick or toothpick. Most of these injuries 
happen in the wilds, where such chemicals can not be obtained. 
Cauterization may then be performed by heating a nail, a knife blade, 
or some other metallic object, such as a suspender buckle, in a fire 
and freely burning all parts of the wound. On hunting trips a car¬ 
tridge may be torn open and a little gunpowder poured on the wound 
and then ignited with a match. Permanganate of potash has been 
highly recommended, and is used by injecting a 1 per cent solution 
into the wound and also into the surrounding tissues bv means of a 
hypodermic syringe. The crystals of permanganate of potash may 
be rubbed into the wound. 

After the wound has been sucked and cauterized so as to extract 
and destroy as much of the poison as possible, the tourniquet may be 
loosened. It should be allowed to remain loose for one minute and 

then tightened up again. Wait 20 minutes and if no alarming symp- 

% 

toms develop it is again released, and this time allowed to remain 
loose for two minutes, after which it is tightened. Another period 
of 20 minutes is allowed to elapse, and on this occasion the tourniquet 
is left off for three minutes. This procedure is continued for several 
hours, gradually increasing the time the tourniquet is off, and is 
known as using the intermittent tourniquet, the object being to allow 
only small quantities of the poison to get into the system at one time. 

If in spite of the local measures and the use of the tourniquet 
general symptoms develop, the patient must be given stimulants. It 
is commonly believed that large doses of whisky or alcohol in some 
form should be administered. This is a mistake, as large doses will 


202 


PREVENTION OF DISEASE AND CARE OF SICK. 


do harm by adding another depressant to that which is already in 
the system. 

Instead of whisky it is better to give aromatic spirits of ammonia, 
one-half teaspoonful in water every hour, and a half a cupful of very 
strong coffee every two hours. 

External heat is sometimes useful. A compress wet with boric- 
acid solution should be applied to the wound after the cauterization. 

Of recent years serums have been produced which are very effective 
in certain kinds of snake bites, but they are rarely obtainable when 
most needed. 

INSECT STINGS. 

BEE STING. 

The stings of bees and wasps and yellow jackets are very painful 
but not dangerous to life unless the victim is attacked by a large num¬ 
ber of the insects. 

Treatment .—If the sting remains in the flesh it should be pulled 
out and a drop or two of diluted ammonia water applied to the 
wound. A compress wet in cold water or cold boric-acid solution will 
help to allay pain. 

STINGS OF CENTIPEDES, TARANTULAS, AND SCORPIONS. 

The stings of these insects are very much more severe than those 
of wasps or bees and may cause considerable general weakness, head¬ 
ache, sweating, and vomiting, but they are practically never fatal. 

Treatment .—The wound should be encouraged to bleed as much as 
possible and afterwards cauterized with carbolic acid or some other 
caustic if available. Tincture of iodine may be applied. An ice com¬ 
press should be placed over the wound to limit local reaction. Gen¬ 
eral symptoms, such as prostration and headache, should be treated by 
moderate stimulation, giving aromatic spirits of ammonia, 30 drops 
in water every hour and supplementing this with half a cupful of 
very strong black coffee if necessary. Some authorities recommend 
the application of a constricting band, which is gradually loosened in 
order to prevent the poison from being taken up. by the system 
rapidly. 

DOG BITES. 

»• m « 

Dog bites are usually minor lacerated wounds, but are especially 
dreaded on account of the danger of hydrophobia, which is almost 
invariably fatal. 

Treatment of dog bites .—If a person is bitten by a healthy dog. 
the wound should be thoroughly swabbed with iodine, working the 
medicine well into all parts of the wounded flesh with a small swab 
of cotton on a clean toothpick and the wound treated in other re- 


PREVENTION OF DISEASE AND CARE OF SICK. 


203 


spects as an ordinary lacerated wound. If the dog is sick, he should 
be confined and carefully watched. If he remains well for II days, 
there is little danger of hydrophobia developing in the patient. In 
no case should the dog be killed unless it is certain he is rabid, 
as in this way it will be impossible to tell whether or not he had 
rabies unless the head is sent to a laboratory for examination. If 
the dog has hydrophobia or is suspected of having hydrophobia at 
the time the injury is recived, the wound should be thoroughly cau¬ 
terized with pure nitric acid on a glass rod or the end of a match 
stick in the same manner as directed for the tincture of iodine. The 
acid should be worked thoroughly into all parts of the wound, and 
the point of a glass medicine dropper makes an excellent instrument 
for this purpose. Care should be taken not to get the acid on the 
sound skin. Carbolic acid, followed by alcohol, may be used for the 
same purpose, but is not as efficient. This cauterization should, of 
course, be done by a physician if one is available. After the cau¬ 
terization the patient should receive the Pasteur treatment, which 
consists of a series of injections covering a period of some weeks. 

SYMPTOMS OF HYDROPHOBIA OR RABIES IN A DOG. 

It is advisable that the public should know something about the 
symptoms of hydrophobia in animals. A dog which is developing 
the disease may show hardly any symptoms except weakness. Usu¬ 
ally, however, the animal shows a marked change in disposition, re¬ 
fuses his food, is apprehensive and very restless. He is liable to run 
away from home, snap at anything in his way, and swallows sticks, 
stones, and other strange objects. Later on paraylsis develops in the 
lower jaw. The jaw hangs down and saliva drools from the mouth. 
In the last stages the hind legs become paralyzed and the dog drags 
them. One should be especially careful about attempting to relieve 
a dog who apparently has some foreign object in the throat, the 
symptoms being that the jaw hangs down and saliva runs from the 
mouth. Such animals are very apt to be rabid, and if the hand is 
inserted into the mouth in an attempt to remove the supposed foreign 
body, the person may be bitten or injured accidentally by the teeth 
and infected with the disease. Hydrophobia usually does not develop 
within less than 10 days after the person is bitten, three weeks being 
about the average period. In rare instances the disease has appeared 
many months after the receipt of the injury. If the dog is suspected 
of being mad and has been killed after biting some one, the head 
should be cut off, packed in ice, and sent by express to the nearest 
laboratory for examination. Usually such laboratories are main¬ 
tained by State health departments at the State capital. 

Other animals besides dogs contract the disease, especially wolves, 
and occasionally cattle develop it. 


204 


PREVENTION OF DISEASE AND CARE OF SICK. 


BITES OF CATS AND OTHER SMALL ANIMALS. 

These injuries are usually punctured and slightly lacerated 
wounds. The proper treatment is the application of tincture of 
iodine thoroughly worked into the wound, followed by a sterile 
dressing. 

MOSQUITO AND FLEA BITES. 

Treatment .—The itching and irritation from these bites can be re¬ 
lieved by a lotion of carbolic acid and boric acid. It should be ap¬ 
plied by dabbing on with a small wad of cotton, or better still by 
spraying it on the surface with an atomizer. To make the lotion, add 
a level tablespoonful of boric acid powder and 20 drops of pure car¬ 
bolic acid to a half a pint of hot water. Stir well or ’shake until 
the boric acid is dissolved. Cool before using. 

HEMORRHAGE OR BLEEDING. 

THE CIRCULATORY SYSTEM. 

The blood is a fluid which circulates through the body in closed 
tubes called blood vessels. There are three kinds of blood ves¬ 
sels, the arteries, veins, and capillaries. The blood flows from the 
heart in the arteries and returns to the heart in the veins. The capil¬ 
laries are verv minute channels which connect the arteries and veins 
(fig. 160). It is necessary for the blood to be in constant motion 
in order that food and oxygen may be carried to all parts of the body 
and waste substances removed. 

The heart is situated behind the breast bone, almost in the middle 
of the chest but slightly to the left side. The function of the heart 
is to force the blood through the arteries and keep it moving. 

The heart beats at the rate of 72 times per minute in a normal per¬ 
son. Excitement, fever, exercise, shock, hemorrhage, and many 
other conditions cause the heart to beat faster. 

As long as the blood is circulated through its proper living chan¬ 
nels it remains fluid, but when it escapes from the blood vessels in a 
short time it hardens and clots. The clotting of the blood forms a 
firm plug which serves to close the blood vessel and checks bleeding. 
Exposure to the air and the admixture of foreign substances hastens 
the formation of the clot. The clotting of the blood when it gets 
outside of the circulatory system, is a wise provision of nature as 
otherwise a slight wound would frequently cause death. There are 
certain individuals whose blood has very slight clotting power. It 
is very difficult to check bleeding from such persons and they are 
known as “ bleeders.” 

The blood in the arteries is under considerable pressure due to the 
action of the heart. The pressure of the blood in the veins is very 


PREVENTION OF DISEASE AND CARE OF SICK. 


205 


slight. It is very much easier to check hemorrhage from a vein 
than from an artery as the blood rushes from tlie artery so rapidly 
that there is no time for the formation of a clot in the vessel. Blood 
from a cut artery flows in spurts or a fine jet, and it is bright red. 
Blood from a cut vein flows steadily, does not spurt, and is dark red 
in color. Blood from cut capillaries flows steadily and is bright red. 

ORDINARY BLEEDING. 

In most wounds there is simply hemorrhage from the capillaries. 
The blood is red and flows steadily for a few moments, then the 
flow becomes slower and finally loss of blood spontaneously ceases. 
Bleeding, from by far the greater majority of wounds, is of this 
type. Such slight hemorrhage in reality is beneficial because it 
serves to wash bacteria out of the tissues if any have been deposited 
there. If bleeding from ordinary wounds does not cease spontane¬ 
ously, it can practically always be checked by placing a pad of gauze 
over the wound and pressing it against the wound either by the hand 
or a bandage, in the meantime elevating the injury if it is in the arm 
or leg (fig. 162). Many wounds are on the extremities and this simple 
expedient of applying pressure and raising the part will be all that 
is required to control the bleeding in most cases. 

Occasionally a wound of this kind begins to bleed a second time 
after it has been dressed for an hour or two. This may be due to 
the fluid blood which is in the dressing acting as a poultice on account 
of the heat of the body. In these cases removing the dressings, ele¬ 
vating the part, and exposing the wound to the cool air, will cause 
the hemorrhage to stop and a new dry dressing can then be applied. 

Reference is frequently made to slight bleeding and severe bleed¬ 
ing, but it may be difficult for the inexperienced to decide just what 
is meant by these terms, as any loss of blood is disturbing to the 
patient and the bystanders. In deciding whether or not bleeding 
should be classed as severe it should always be remembered that 
even a small quantity of blood will make quite an alarming stain on 
the linen or clothing, but the important thing is to note the rate at 
which the blood is actually escaping from the wound itself. The 
wound should be exposed for this purpose, with the patient sitting 
or lying quietly in a comfortable position. If the total blood escap¬ 
ing from the wound falls from the part in separate drops, the bleed¬ 
ing can hardly be called severe. 

Sometimes a small amount of bleeding will continue for a long 
time. If the loss of blood is negligible, in such a case it is generally 
customary to proceed with the dressing, relying upon the pressure of 
the gauze to ultimately stop the hemorrhage. 

40071°—23-10 



206 


PREVENTION OF DISEASE AND CARE OF SICK. 


Anything which makes the heart beat faster will increase hemor¬ 
rhage, hence it is unwise to give stimulants to bleeding patients unless 
absolutely necessary to save life, and in all cases they should be kept 
in a recumbent or semirecumbent position and as quiet as possible. 

Do not put styptics, such as Monsel’s solution, turpentine, cobwebs, 
and similar substances in wounds to stop bleeding. Bleeding can 
be control-led b}^ other methods, and the use of styptics is undesirable 
as a general rule. 

OOZING. 

Occasionally considerable oozing will persist from a wound which 
is possibly not deep but extensive. Such oozing can almost always 
be controlled by the pressure of a properly applied compress, but 
if this fails the wound may be irrigated with hydrogen peroxide, 
which is an excellent means of stopping such loss of blood. In the 
absence of hydrogen peroxide very cold water or water as hot as 
can be borne should be tried. Do not, however, use lukewarm water, 
because it will increase the bleeding instead of diminishing it. 

VENOUS HEMORRHAGE. 

When a vein has been cut the blood wells up in the wound steadily 
and is dark red in color, sometimes almost black. If the vein is large, 
the blood flows rapidly, and a considerable amount may be lost. Such 
hemorrhage can be stopped by simply pressing a pad of sterile gauze 
over the wound and then elevating the part, having the patient lie 
down. 

BLEEDING FROM VARICOSE VEINS OF THE LEG. 

Occasionally these veins rupture and rather profuse hemorrhage 
occurs. In such a case the proper treatment is to lay the patient 
down, raise the leg and foot Avell in the air, and apply a clean gauze 
pad or as clean a pad of muslin as can be obtained on the ruptured 
vein, making light pressure on the compress with a bandage. Be 
sure to remove all garters or other constricting bands. If the hemor¬ 
rhage continues in spite of this treatment the effort of loosening that 
part of the bandage which is between the heart and the wound should 
be tried. It may be that the bandage is improperly placed and is 
obstructing the return flow of blood to the heart and increasing the 
hemorrhage. 

PACKING A WOUND TO CHECK HEMORRHAGE. 


Where the hemorrhage is of a moderate amount it is always best 
to try the effect of elevation and pressure first. If these fail and the 
bleeding continues persistently it may be necessary to resort to pack- 



Fig. 161.—Stopping hemorrhage by pressure with a pad of gauze in 

the hand. 



Fig. 162.—Stopping hemorrhage by pressure on a pad of gauze with a 

bandage. 



Fig. 163.—Method of packing a wound. 
The gauze is being forced into the wound 
with the point of a closed pair of scissors. 




































Fig. 164.—Wound packing finished. 



Fig. 1G5.—Elastic tourniquet. 



Fig. 106.—Elastic tourniquet applied. 













PREVENTION OF DISEASE AND CARE OF SICK. 


207 


ing the wound. Packing a wound is very similar to stopping a small 
leak in a boat by forcing a strip of muslin into the opening, and any 
person of ordinary intelligence can learn how to do it. The pro¬ 
cedure is somewhat in the order of a minor surgical operation and 
should not be undertaken if it can be avoided, as germs may be car¬ 
ried into the wound by the procedure. 

RULES FOR PACKING WOUNDS. 

1. In first-aid work if a doctor will arrive soon and severe bleeding 
of an extremity can not be stopped by elevation and the pressure 
of a pad on the wound, apply a tourniquet (p. 208). 

2. If it is certain that medical aid can not be obtained in 4 hours, 
and the bleeding can not be checked by pressure and elevation of 
the part and becomes alarming, pack the wound. 

3. Packing is also used to control hemorrhage from wounds of the 
trunk or neck which can not be controlled by pressure. Tourniquets, 
of course, can not be applied in these localities. 

PREPARATION FOR PACKING A WOUND. 

Everything which goes into the wound should be sterile, hence it 
may be necessary to apply a tourniquet (p. 208) to stop the bleeding 
while suitable preparations for packing are being made. The tourni¬ 
quet should be loosened as soon as everything is ready. The bleeding 
may not recur, in which case packing will not be required. If bleed¬ 
ing of importance starts when the tourniquet is loosened, pack the 
wound. 

Strips of sterile gauze or iodoform gauze make excellent packing 
material. If these are not at hand, strips of clean muslin may be 
boiled for 10 minutes, the water poured off and the strips dried as 
well as possible by continuing to heat them in the pan with the lid 
off. Be sure there is enough material to fill the wound tightly. 
The muslin can be boiled at the same time as the instruments but 
in another pan. • 

METHOD OF PACKING. 

Scrub the hands carefully for 10 minutes in soap and water, chang¬ 
ing the water frequently. Then soak them in a 1-2,000 bichloride 
of mercury solution if available. In the meantime boil in a pan on 
the stove a pair of scissors, a hairpin, a stick of wood similar to a 
penholder in size and shape, and a pair of dressing forceps and 
artery forceps if they are at hand. Pour the water off of the in¬ 
struments and allow them to cool in the pan without touching them. 
Dry out the strips of muslin or gauze if it has been necessary to 
boil them. Place the instruments and the pan of packing material, 
gauze or muslin, alongside of the patient. Wash the hands again. 


208 


PREVENTION OF DISEASE AND CARE OF SICK. 


Cut the gauze or muslin with the boiled scissors into strips about 18 
inches long and narrow enough to go into the wound easily and place 
these strips back in the pan. Remove the dressing from the wound 
and work the narrow strips into the wound by means of the closed 
points of the scissors, the stick or the forceps (fig. 163). A small 
metallic screw driver makes an excellent packing instrument. 

The gauze is pushed firmly into the bottom of the wound first and 
the wound gradually filled from the bottom up. Considerable pres¬ 
sure must be used to pack the wound effectively. If the wound is 
somewhat cone-shaped the gauze may be packed firmly into the 
opening and then held in place by a bandage properly applied. 
Sterile packing can be allowed to remain undisturbed for 24 to 48 
hours. Before starting in to remove it, sterilize the hands and have 
sterile instruments and materials ready for repacking in case hemor¬ 
rhage recurs. Have a tourniquet at hand also. Take the packing out 
slowly and gently. If serious bleeding follows the removal of the 
packing, apply 7 the tourniquet and repack. If the wound does not 
bleed, swab with tincture of iodine and dress with sterile gauze. 

EMERGENCY PACKING. 

Whenever circumstances permit the above procedure should be 
faithfully carried out before packing a wound. Even in camps or 
remote districts pans and a fire can generally be obtained and the 
bleeding controlled by a temporary tourniquet while the necessary 
articles are being boiled. However, if it is impossible to secure 
sterile materials, use the cleanest things obtainable. Strips torn 
from a clean handkerchief, towel, napkin, or the sleeve of a shirt 
can be forced into a wound with a narrow stick, a buttonhook, a long 
wire nail, or a pencil. It is better to run the risk of infecting a 
wound than to allow a man to bleed to death. Such packing, how¬ 
ever, should be removed as soon as sterile material can be obtained 
and the wound repacked if bleeding starts in afresh. 

ARTERIAL HEMORRHAGE. • 

Blood from arteries comes in spurts or a fine jet and is bright red, 

Treatment .—Very small bleeding arteries can often be controlled 
by pressure and slightly larger ones by packing, but as a general 
rule, if the artery is of any size and in an extremity, it will be best to 
apply a tourniquet immediately. 

TOURNIQUETS. 

Tourniquets are appliances used to check hemorrhage by com¬ 
pressing the arteries somewhere between the heart and the wound. 
It is well known that the flow of water through a soft tube, such as 
the tubing used on a fountain syringe, can be easily stopped by 



Fig. 167.—Inelastic tourniquet applied to 
main artery of thigh. Note compress 
over main artery under tourniquet. 
Stick is prevented from untwisting by 
necktie above the knee. 


Fig. 168.—Emergency tourniquet twisted up by the hand. 


Fig. 170,—Compressing main artery in the arm 
with the thumb. 


Fig. 172.—Compression of main artery 
in the thigh with thumb. 































Fig. 173.—The use of two pads to avoid bruising the flesh 
under the tourniquet and main artery of arm. Pair of 
shears used as a lever to twist up tourniquet and held in 
position by handkerchief around the elbow. 



Fig. 174.—Spoons bent into retractors for 
wounds. 



Fig. 173.—Artery forceps. 















PREVENTION OF DISEASE AND CARE OF SICK. 


209 


pinching the rubber between the fingers. Hemorrhage from a wound 
can be controlled in the same manner by pressing the main artery 
with the fingers or a pad against the bone which lies underneath or 
by making constriction around the limb by a very tight band. 

There are two varieties of tourniquets. In hospitals and on am¬ 
bulances a strong rubber band about 3 feet long, with chains and 



3. Tourniquet on Brachial Arterv 



Fig. 159. —Stopping bleeding. (Courtesy of the American Red Cross.) 


hooks on the ends for fastening, is generally used for this purpose. 
This is known as an elastic tourniquet, and is very convenient, 
because it can be quickly applied by anyone and controls hemorrhage 
very effectively (fig. 165). 

In first-aid work it may be often necessary to improvise a tourni¬ 
quet. For this purpose a handkerchief, necktie, towel, or any piece 
of material of sufficient strength, which can be knotted around the 
















210 


PREVENTION OE DISEASE AND CARE OF SICK. 


limb and twisted up with a stick, is frequently used. These are 
known as inelastic tourniquets, and when using them it is advisable, 
when time and circumstances permit, to place a pad over the main 
artery so as to make pressure on it directly (fig. 167). 

PROVISIONAL TOURNIQUETS. 

In an emergency when an artery of considerable size has been 
opened the helper should immediately take a handkerchief, necktie, 
towel, or even a wide strip torn from the shirt of the patient, and tie 
it around the arm or leg which is wounded, placing the knot so that 
the encircling band is slightly larger than the circumference of the 
part. Adjust the band so that it is several inches from the wound 
and between the wound and the heart. Grasp the band firmly in the 
palm of the hand and turn the hand around, thus tightening and 
twisting the tourniquet (fig. 168). This will instantly stop the flow 
of blood and give the helper a chance to collect his wits and decide on 
his further course of action. He holds the tourniquet thus tightened 
until a stick, ruler, screw driver, a long pair of scissors, chair rung, 
or any similar article has been obtained and then slips this instru¬ 
ment into the loop in place of his hand and uses it to twist up the 
tourniquet. The band is tightened by twisting the stick, or whatever 
is used as a lever, just enough to stop the bleeding and no more. All 
tourniquets are very painful, and as great leverage is secured by 
means of the stick special care must be exercised in tightening them, 
as serious damage may be inflicted on the nerves and structures 
beneath by too great pressure. Always watch the wound, and the 
moment the hemorrhage ceases stop turning the lever. When just 
the right amount of pressure has been applied, fasten the stick in the 
proper position by a handkerchief or strip of some material, looped 
first around it and then passed around the part (fig. 173). The bleed¬ 
ing is now controlled for the present, and further procedure will 
depend upon how soon medical aid can be obtained. 

1, If the accident has happened in a city or town and medical help 
will certainly be available within an hour, nothing further need be 
done except to send for a doctor and make the patient as comfortable 
as possible in the interval. Proper measures should be taken to pro¬ 
tect the wound from the entrance of bacteria, as already described. 

2. If it will probably require two or three hours to secure a physi¬ 
cian, the helper should endeavor to improvise some sort of an elastic 
tourniquet to replace the nonstretching band which was applied at 
first. Elastic tourniquets are very much better than the inelastic ones, 
because they do less damage to the tissues and are less painful. The 
inner tube of a bicycle tire makes an excellent tourniquet; also a strip 
about 1 inch wide and 4 or 5 feet long cut from the inner tube of an 
automobile tire. Practically all automobilists carry these spare tubes, 


PREVENTION OF DISEASE AND CARE OF SICK. 


211 



Fig. 169.—Course of the 
main artery in the arm. 
Cross show point for ap¬ 
plying pressure. 


and it may be possible to obtain one. A couple of pairs of elastic 
suspenders can be constructed into a tourniquet. 

Elastic tourniquets are applied by taking 
two or three turns fairly snugly around the 
limb and then gradually pulling harder on 
the long end until the hemmorrhage stops. 

The remainder of the tourniquet is then 
wound around over the original turns, 
stretching it sufficiently so that the proper 
amount of pressure is maintained. The ends 
are then tied or twisted together and pre¬ 
vented from slipping by tying a string 
tightly around them. 

If an elastic tourniquet can not be secured 
it may be advisable to apply a tourniquet 
higher up on the limb with a suitable pad 
over the main artery. A carefully con- 
structed band with a suitable pad properly 
placed so as to compress the large artery sup¬ 
plying the part controls the hemmorrhage with less pain and damage 
to the tissues than the simple constricting tourniquet which is applied 
to immediately stop the loss of blood. 

METHOD OF APPLYING TOURNIQUETS TO MAIN ARTERIES. 

To apply such a tourniquet properly one should know the location 
of the large artery which supplies the part. In the arm the main 

artery runs downward on the inner side and its 
location corresponds very closely to the inside 
seam of the sleeve in the upper part of the arm 
(fig. 169). In the upper part of the thigh the 
main artery will be found in the front part of 
the thigh just a little to the inside of the crease 
of the trousers (fig. HI), and may be easily com¬ 
pressed by pressure directly downward against 
the thigh bone (fig. 172). All inelastic tour¬ 
niquets should be fairly broad to avoid bruising 
the flesh. Where a pad is used it is wise to place 
a folded towel under the tourniquet on the op¬ 
posite side of the limb to prevent it from cutting 
too deeply into the flesh (fig. 173). The band is 
placed around the limb near the armpit in the 
case of the arm, or close to the groin for the 
lower extremity. The exact location of the 
artery can be determined by searching for it in 
its proper location by the finger tips, the artery being recognized as 
a fairly large pulsating cord. The pad which may be a tightly folded 



Fig, 171.—Course of 
main artery in the 
thigh. Cross shows 
point for applying 
pressure. 





212 


PREVENTION OF DISEASE AND CARE OF SICK. 


handkerchief, a smooth stone, wrapped in cloth, a flat cork, or even 
a watch, is placed over the artery in such a position that the pressure 
• of the band will pull it down on the artery and compress the artery 
against the bone underneath. The tourniquet is wrapped around the 
pad and the limb, tied loosely, and then lightly twisted up with a 
stick or similar object, as above described. The lower provisional 
tourniquet is now loosened and removed. It may be found that the 
bleeding has ceased, in which case no tourniquet will be necessary. If 
the bleeding begins as soon as the lower tourniquet is loosened, the 
upper one is tightened sufficiently to check the hemorrhage and the 
stick fastened in the proper location (fig. 167). 

Tourniquets can only be used on the extremities or around the fore¬ 
head. In any case of severe bleeding one should instantly compress 
the main artery bv means of the thumb or fingers and control the loss 
of blood in this manner while a tourniquet is being improvised or 
procured (fig. 172). The vessel can not be held with the fingers for 
more than a few minutes, as the operator will very quickly become 
fatigued. 

Venous hemorrhage from the extremities can also be controlled by 
a tourniquet if sufficient pressure is applied to close the arteries which 
are sending the blood to the veins. If the application of the tour¬ 
niquet between the wound and the heart apparently increases the 
hemorrhage instead of checking it, it is due to the fact that veins are 
wounded and the tourniquet is not properly applied so as to com¬ 
pletely shut off the arterial blood supply, but is interfering with the 
venous return, therefore making the hemorrhage worse instead of 
better. In such a case tourniquet and pad should be readjusted and 
more pressure applied. If the hemorrhage is of mixed origin, both 
veins and arteries being severed, as is generally the case, the control 
of the arteries is all that will be required, and as soon as they are 
properly compressed the bleeding, both venous and arterial, will cease. 

In ordinary first-aid work tourniquets are applied simply to check 
the loss of blood until the doctor arrives to assume charge of the 
case. If no doctor is available or can not be reached for a considerable 
time, it will be necessary for the operator to proceed immediately 
after the application of the tourniquet to consider other means of 
checking the homorrhage permanently, because it will be necessary, as 
has been stated above, to remove the tourniquet sooner or later. 

If the services of a doctor can not be secured in the immediate 
future, the case becomes a somewhat difficult one, because tourniquets 
can not be left in position for an indefinite time. The tissues require 
the circulation of the blood in order to keep them alive, and if the 
blood is shut ofl* too long the part will die and gangrene follow. 
Tourniquets, then, must be classed solely as a temporary expedient 


PREVENTION OF DISEASE AND CARE OF SICK. 


213 


for checking severe hemorrhage until some other means can be em¬ 
ployed. It is certainly not safe to allow a tourniquet to remain on 
longer than three hours. It must also be remembered that the great 
pressure exerted in twisting up a band with a stick in the manner 
described may inflict severe injury on the nerves or other structures 
if continued for too long a period. A case has been recorded in 
which a heavy cord was wrapped around the wrist and twisted up 
with a policeman’s night stick and so much damage done to the 
tissues inclosed by the cord that the patient never recoverd the full 
use of the hand. 

If a layman finds that he must assume the after treatment of 
such a patient, he has two procedures to adopt. The wound may be 
packed or the bleeding artery tied. If the severed artery is small, 
packing will probably be successful. If the artery is large, it must 
be tied. The size of the arterv may be estimated by the amount of 
blood which comes from the wound before the tourniquet was ap¬ 
plied. If in doubt as to which course to pursue it is generally best 
to pack the wound, then if packing fails, an attempt may be made 
to tie the artery later. It is possible to pack such a wound under 
practically all circumstances, hence this will be the method of choice 
if the accident has happened in the woods or some other remote 
place, when the necessary materials for tying an artery are not at 
hand and can not be improvised. 

TYING ARTERIES. 

Arteries may be tied with either silk, linen, or cotton thread. The 
string used for tying an artery is called a ligature . Surgeons often 
use specially prepared sterile catgut ligatures because this material 
is absorbed in time by the tissues and causes less trouble than silk 
or cotton if the wound becomes infected. The strength of the string 
selected depends upon the size of the artery. Fairly large arteries 
should be tied with strong string similar to that used by grocers, 
while medium-sized vessels can be safely closed with one or more 
strands of heavy thread such as is used for sewing on buttons. 

In order to find the artery and get at it, it will generally be neces¬ 
sary to have an assistant pull the edges of the wound apart with 
some sort of an instrument. The handles of tea or table spoons can 
be used for this purpose. Bending the handle at a right angle to 
the shaft about 2 inches from the end makes a sort of hoe-shaped in¬ 
strument very suitable for this purpose and enables the assistant to 
hold the wound open without getting his hands in the way of the 
operator (fig, 174). For a large, deep wound use tablespoons. 

METHOD OF TYING ARTERIES. 

Boil 2 tablespoons, 2 teaspoons, a pair of scissors, a hair pin or 
probe, several artery forceps, if they are available, 4 or 5 stout 


214 


PREVENTION OF DISEASE AND CARE OF SICK. 


needles, and a dozen pieces of stout thread about 12 inches long. If 
possible, the operator should have two assistants, one to manipulate 
the tourniquet, the other to sponge the wound. While the instru¬ 
ments are boiling, the operator and one assistant should carefully 
prepare their hands according to the method described on page 184. 
Artery forceps are provided with locks so that when the handles are 
closed the points of the forcep will firmly hold any material which 
is within their grasp (fig. 175). When the instruments have been 
boiled and cooled, and the hands sterilized, the operator places 
them alongside of the patient in the pans and fearlessly scoops out 
all blood clots from the wound. The edges of the wound are held 
apart by means of the handles of the tablespoons in the hands of the 
assistants, so that the interior of the wound can be freely inspected. 
The wound is dried by pads of sterile gauze. The third assistant now 
loosens the tourniquet a little. The operator watches the wound 
carefully, and as soon as the place from which the blood is coming 
is located, he grasps a small part of the tissues around the opening 
with the blades of the artery forcep and locks the handles. If the 
forcep is applied in the proper manner this should check the bleed¬ 
ing from that spot. If other freely bleeding points are noticed they 
are grasped with the other forceps. The operator may have to make 
several attempts before he gets the forceps properly applied so that 
it closes the opening in the blood vessel. The tourniquet can be 
tightened between each attempt and the blood cleaned out of the 
wound before making another trial. When the bleeding point has 
been properly grasped, the assistant makes gentle traction on the 
forceps so as to raise the tissues slightly from the side or bottom of 
the wound. One or more of the prepared strands of thread are 
now placed around the forcep and worked down to the point. The 
handle is depressed and a single surgeon’s knot tied loosely in the 
thread, which is worked downward with the tips of the fingers so as 
to grasp the tissues below the point of the forcep. The point must 
not be included in the ligature or otherwise it will be displaced when 
the forcep is removed. 

Having gotten the ligature in the proper position hold it there 
with a probe, hairpin, or other narrow instrument while the knot 
is drawn up tightly and several other knots added for additional 
security. The first knot should be what is known as the surgeon’s 
knot, which can best be understood by looking at figure 177. When 
the knots are firmly in place the handles of the forceps are unlocked 
and it is carefully withdrawn. The ends of the ligature are now 
cut off about one-third of an inch from the knots. The same pro¬ 
cedure is applied to any other forceps which have been in use.- In 
the absence of an artery forcep a needle may be inserted into the 
tissues under the bleeding point, the tourniquet tightened, the needle 



Fig. 176.—Method of tying artery with artery forceps. 



Fig. 177.—Surgeon’s knot, first step. 
(From Da Costa’s Surgery. Courtesy 
W. B. Saunders Co.) 



Fig, 178.—Method of tying artery over a needle, 
































Jig. 180.—Point for applying pressure for check¬ 
ing hemorrhage from the forehead. 



Fig. 181.—Method of applying tourni¬ 
quet around forehead to check severe 
hemorrhage from the scalp. 



Fig. 1S2.—Point of applying pressure in hemor¬ 
rhage from the lips or cheek. 





















PREVENTION OF DISEASE AND CARE OF SICK. 


215 


raised slightly so as to draw the tissue away from the wound, and a 
piece of thread tied under the needle so as to include a small amount 
of flesh, the ends cut off one-third of an inch from the knots, and 
then the needle withdrawn (fig. 178). After the hemorrhage has 
been checked by tying up the bleeding points and no serious bleeding 
occurs when the tourniquet is loosened, the wound may then be 
swabbed with tincture of iodine and closed by stitches, if it gaps 
widely, and a wick composed of a number of strands of thread left 
in the lower corner of the wound hanging out for about an inch for 
drainage. This wick is removed in 48 hours if no signs of inflamma¬ 
tion occur, and the stitches can be removed in from five to six days. 

In desperate cases, when all other measures fail, and the bleeding 
recurs every time the tourniquet is removed, it may be necessary to 
sear the bleeding point or places in the wound with a hot iron in 
order to check hemorrhage and save life. An iron rod, such as a 
poker, bolt, or large wire nail, may be heated for this purpose over 
any fire and should be sufficiently hot to thoroughly cook the flesh 
with which it is held in contact. After the wound has been seared 
no attempt should be made to close it with stitches. 

AFTER TREATMENT OF SEVERE HEMORRHAGE IN GENERAL. 

Patients who have lost a great deal of blood are in a weakened 
condition and may require careful after treatment. They should be 
kept in bed and all possible movement avoided, not even permitting 
them to go to the toilet in severe cases. The food should be light but 
nutritious and given in small quantities at frequent intervals. Milk 
toast, broth, and raw egg beaten up in milk, thin custards, etc., makes 
a good diet for the first few days. Afterwards it may be advisable 
to give closes of iron and strychnine to assist in building up the 
general strength. One-sixtieth of a grain of strychnine sulphate may 
be given three times a day, a half an hour before meals, and five 
drops of the tincture of iron in water at meal time, to be taken 
through a tube in order to avoid staining the teeth. 

The patient should be kept in bed until his color has improved and 
should not be permitted to do hard work for some time. 

BLEEDING FROM SPECIAL PARTS. 

HEMORRHAGE FROM THE SCALP. 

See wounds of the scalp, page 199. 

HEMORRHAGE FROM THE FACE AND FOREHEAD. 

The face has an abundant blood supply and bleeds freely when cut. 
Usually pressure with a compress against the bone underneath will 
be sufficient to arrest ordinary bleeding. 

40671 °— 23-17 + IS 



216 


PREVENTION OF DISEASE AND CARE OF SICK. 


If the blood comes in spurts from a wound of the forehead, apply 
pressure with the thumb in front of the ear, as the main artery passes 



sure to check hemorrhage. 

HEMORRHAGE 


up in this location (figs. 179 and 
180). 

A large artery which crosses the 
lower jawbone supplies the lips, 
cheeks, and nose. Severe bleeding 
from these localities may be con¬ 
trolled by pressure on this artery 
made against the jaw about 2J 
inches from the point of the chin 
(figs. 179 and 182). In endeavoring 
to stop hemorrhage by pressure of 
the fingers on a main artery, it may 
be necessary to shift the position of 
the fingers slightly in various direc¬ 
tions until the proper spot is lo¬ 
cated. 

FROM THE NECK. 



There are many large blood vessels in the neck, and if one or more 
of these are severed furious bleeding results. 

First-aid treatment .—It 
is impossible to apply a 
tourniquet to the neck, as it 
would cause immediate suf¬ 
focation. Pressure inward 
and backward against the 
backbone should be made 
by the thumb, placed just 
above the breastbone. Make 
the pressures slightly from 
the side to avoid closing the 
■windpipe (fig. 184). If the 
hemorrhage is very severe, 
push the first available ma¬ 
terial at hand, such as a 
handkerchief or the end of 

a towel, into the wound, Fig. 183.—Main arteries of the neck. Crosses show 

and hold it in place with P° ints for applying pressure to check hemorrhage 

* . from neck, shoulder, or arm pit. 

backward pressure against 

the backbone. Send for a doctor at once. Have the patient sit up 
in a chair. 

After treatment .—It will be necessary to hold the compress in place 
or a long period. Several persons may relieve each other in this 




PREVENTION OF DISEASE AND CARE OF SICK. 217 


'work. If artery forceps are available, it may be possible to grasp 
the bleeding vessels and tie them with boiled heavy thread. 


HEMORRHAGE FROM THE TRUNK. 

Tourniquets can not be used to check 
bleeding from wounds of the chest, back, 
or abdomen. Hemorrhage from such lo¬ 
calities is controlled by pressure, and when 
that fails by packing. 

HEMORRHAGE FROM THE PALM OF 
THE HAND. 

Bleeding from deep wounds of the palm 
may often be checked by placing a large, 
firm, ball-shaped pad in the palm, closing 
fingers around it tightly, and bandaging 
them in place. A round stone wrapped in 
a handkerchief makes an excellent emer¬ 
gency pad for this purpose. 



Fig. 184.—Point of applying 

pressure to check hemor¬ 
rhage from the neck. 


HEMORRHAGE FROM THE NOSE. 


If it becomes necessary to check nosebleed the patient should be 
placed in a semirecumbent position, that is, lying on a bed or couch 
with shoulders and head slightly elevated. This can be easily done 

'by placing a tipped-over chair 


behind the patient (fig. 186). A 
flexible roll about 2 inches long 
and one-third of an inch in 
diameter should then be made 
out of newspaper or muslin and 
forced under the upper lip. 
This pad goes well up between 
the gum and the lip and does 
not rest on the teeth. It should 
be firmly pushed in place and 
should put the lip under con¬ 
siderable tension. The patient 
should remain absolutely quiet 
and should on no account blow 
the nose, as this will detach the 
clot and the hemorrhage will 
start afresh. Ice applied to the 
back of the neck will sometimes 



Fig. 185.—Point of applying pressure to cheok 
hemorrage from the shoulder or armpit. 


prove effective. If these remedies fail and the hemorrhage continues 
for a long time, as a last resort it may be necessary to pack the nostril. 
This is done by introducing into the nose a long strip of gauze or mus- 













218 PREVENTION OF DISEASE AND CARE OF SICK. 

lin about an inch and a half wide by means of a blunt end of a pen¬ 
holder or a similar blunt-pointed instrument. The gauze should be 
packed in firmly, filling the back part of the nostril first and grad¬ 
ually working forward. One end of the strip should be left out of 
the nose in order to facilitate its removal. 

HEMORRHAGE FROM A TOOTH SOCKET. 

This can often be checked by holding ice water or hydrogen perox¬ 
ide in the mouth. Failing in this, make a cone-shaped pad of gauze 
or cotton, force it into the socket, and hold in place by closing the 
jaws tightly. 

HEMORRHAGE FROM THE LUNGS. 

Description .—Hemorrhage from the lungs occurs chiefly in tuber¬ 
culosis, but may be caused by other conditions. 

Treatment .—The patient should be placed in bed in a semire- 
clining position as shown in figure 186. An ice bag should be applied 
to the chest, or a towel rung out in cold water, which is frequently 
renewed. The patient should remain absolutely quiet, and if it is 
obtainable a quarter of a grain of morphine should be given by the 
mouth, or 10 drops of tincture of opium, or a teaspoonful of pare¬ 
goric. It is of no use to give the patient salt as is frequently ad¬ 
vised. Blood from the lungs is coughed up, is more or less frothy, 
and is often bright red in color. 

HEMORRHAGE FROM THE STOMACH. 

Description .—Hemorrhage from the stomach occurs in ulcer of 
the stomach, also in cancer and other conditions. The blood is vom¬ 
ited up and generally mixed with food, and may be bright red or 
dark brown in color. 

Treatment .—Place the patient in bed in a semireclining position. 
Allow him to swallow small pieces of ice. These should be actually 
swallowed and not sucked. If hydrogen peroxide is available a tea- 
spoonful in a little water may be given. If antipyrin is at hand give 
10 grains. Keep the patient absolutely quiet and allow no food for 
at least four hours after all bleeding has ceased. The diet at first 
should be liquid. 

HEMORRHAGE FROM PILES. 

Where the bleeding from piles becomes excessive the patient should 
keep off his feet as much as possible, and in severe cases go to bed. 
The hips should be elevated upon a pillow, and an enema of 4 ounces 
of ice water may be injected into the rectum by means of a fountain 
syringe, and cloths rung out in ice water or an ice bag applied to the 


PREVENTION OF DISEASE AND CARE OF SICK. 


219 


anus. These compresses should be changed every few minutes, be¬ 
cause if they are permitted to become warm they will act as a 
poultice and increase bleeding instead of checking it. 

HEMORRHAGE INTO THE ABDOMEN. 

Severe injuries such as crushes or perforating wounds of the 
chest or abdomen may give rise to internal abdominal hemorrhage. 

Symptoms .—Gradually increasing pallor. The pulse gets rapid 
and weak. There is a peculiar sighing form of respiration. Marked 
thirst. Pain in the abdomen. The patient vomits and is very rest¬ 
less. Later attacks of fainting may come on. 

First-aid treatment .—Send for a physician at once. Place the 
patient in a recumbent position with the head low. Apply cold to 
the abdomen and keep the person as quiet as possible. 

After treatment .—Keep the patient absolutely quiet in bed. Allow 
small quantities of warm water for the thirst. Apply an ice bag or 
cold applications to the abdomen. 

SUMMARY OF THE TREATMENT OF HEMORRHAGE. 

Ordinary bleeding from the arm or leg can be controlled by rais¬ 
ing the part and by pressing a sterile or clean pad firmly on the 
wound. The pad may be held in the fingers or fastened in place by 
tying a handkerchief tightly around the limb. 

If pressure and elevation fail, apply a tourniquet if medical help 
can be obtained soon. If the services of a doctor will not be avail¬ 
able for four hours or longer, pack the wound with stirile gauze or 
muslin. 

In all cases of very severe bleeding of the extremities or when the 
blood comes in spurts apply a tourniquet immediately. 

In hemorrhage from the scalp, fasten a sterile compress on the 
wound by a bandage or handkerchief around the head. Failing in 
this, tie a tight band around the forehead just below the wound. 

In hemorrhage from the neck, press the large artery in the side of 
the neck against the backbone with the thumb. Failing in this, if 
the hemorrhage is severe, pack the wound immediately with any ma¬ 
terial available, using the cleanest thing obtainable. 

In hemorrhage from wounds of the trunk, apply pressure by a 
gauze compress, and failing in this, if the wound is bleeding freely, 
pack it with sterile gauze. 

Tourniquets must not be left on for more than two or at the most 
three hours. 

Remember that a man who has lost a good deal of blood may re¬ 
quire constitutional treatment after the bleeding has been stopped. 


220 


PREVENTION OF DISEASE AND CARE OF SICK. 


SHOCK. 

After a severe accident the patient almost always goes into a pecu¬ 
liar mental and physical condition, which is called shock. This condi¬ 
tion may immediately follow the injury or may not develop for some 
time. Shock may be described as a condition of extreme general 
depression produced by injury or profound emotion. The state of 
shock is somewhat similar in some respects to extreme exhaustion 
or collapse. The amount of shock docs not always correspond to 
the gravity of the injury, some individuals being much more sus¬ 
ceptible to it than others. Shock is dangerous, and every one who is 
treating an injured man should bear it in mind and examine him to 
determine whether it is present. 

SymptoTns of shock .—The face is pale with a dull expression. The 
skin is cold and covered with a clammy perspiration. The pulse is 
weak and rapid. It may be impossible to feel the pulse at the 
wrist. The patient is usually conscious but is in a peculiar state of 
mental indifference, lying with the eyes partially closed and making 
no effort to move. He may respond to questions, but no dependence 
can be placed on the truth of his statements. He rarely feels pain 
and seems to be indifferent to his fate. The breathing is rapid, ir¬ 
regular, and shallow, sometimes gasping. Under suitable treatment 
recovery from the condition may be expected, but in severe cases shock 
may continue and death follow. 

Shock is a merciful provision of nature to prevent suffering on the 
part of injured people. It is stated than animals go into shock, and 
that when carnivorous beasts seize their prey that the victim be¬ 
comes immediately numb and feels no pain. When a cat plays with 
a mouse, which she has captured, the mouse is not suffering the tor¬ 
ture which the observer would imagine. 

When a person makes much continuous outcry after an accident, 
it is probable that his condition is not dangerous. The seriously in¬ 
jured individual lies quiet and may escape notice on account of his 
apparent indifference to what has happened. Where a number of 
persons have been hurt, it is generally a safe rule to give aid first to 
those who are evidently gravely injured but making the least com¬ 
plaint. 

Treatment .—The symptoms of shock give a fairly clear idea as to 
what the treatment should be. The body is cold, hence it should be 
warmly covered, the patient lying in a recumbent position with the 
head low. External heat should be immediately applied by means 
of bottles, jugs, or other containers filled with hot water. These 
should be placed alongside of and between the legs and around the 
feet. In emergencies hot bricks or even hot stones can be used. 
Great care should be taken that the patient is not burnt by these 



Fig. 186.—Propping patient in a semireclining position 

with a chair. 



Fig. 187.—Treatment of shock with emergency hot-water bottles. 



Fi«. 188.—Turning the head to one side when patient vomits, 




















Fig. 190.—Method of making the spiral reverse bandage, 
(From Fowler’s Surgery. Courtesy W. B. Saunders Co.) 



Fig. 191.—Fastening a bandage by split¬ 
ting the ends. 
















PREVENTION OF DISEASE AND CAEE OF SICK. 


221 


appliances, however, and they should be well wrapped with towels, 
old clothing, or similar material, and never placed in direct contact 
with the skin. The heart is weak, hence stimulants should be given. 
The best of these for shock is probably a small quantity of very 
strong hot black coffee. Aromatic spirits of ammonia, one-half a 
teaspoonful in a half tumblerful of water, is also another excellent 
remedy. Very small quantities of warm soup or milk are sometimes 
useful. Atropine sulphate in doses of 1/100 of a grain is highly 
recommended. Do not repeat oftener than every three hours. Liquor 
in shock is of questionable value. Shock is sometimes due to con¬ 
cealed hemorrhage, and this should always be looked for with great 
care. A patient should never be moved while he is in shock, or dis¬ 
turbed in any way, unless it is absolutely unavoidable and necessary 
to save life. This, of course, does not apply to putting a man in an 
ambulance and taking him on a short trip to a hospital, where he 
can receive very much better treatment, or to a man lying on the 
street a cold winter day, where the dangers of a short move into 
a warm house will be more than offset bv the favorable surround- 
ings which are thus secured. 

Unconscious patients can not be given stimulants by the mouth, in 
which case smelling salts can be held under the nose, or a few T drops 
of ammonia water sprinkled on a handkerchief and the patient al¬ 
lowed to inhale the fumes at intervals a minute apart. The applica¬ 
tion of external heat is almost always available, and should be con¬ 
scientiously and thoroughly followed out. There are other forms of 
treatment for shock, but they are only available to the skilled physi¬ 
cian. Eaising the feet or legs and rubbing the extremities toward 
the heart, in order to encourage the flow of blood to that organ, is 
sometimes useful, but these measures are only applicable when the 
patient is in a warm room or on a warm day. 

One can tell that the patient is recovering from shock by the 
disappearance of the symptoms. The face recovers its natural color, 
the skin becomes dry, the respiration is full and regular, and the 
pulse, as felt at the wrist, becomes stronger and slower. When the 
patient has reacted in the above-described manner and the symptoms 
of shock have disappeared, it is then safe to move him or to under¬ 
take other measures necessary for his treatment. 

In reacting from shock, vomiting often occurs. If an unconscious 
person starts to vomit, always turn his head to one side, so that the 
ejected matter runs out of the mouth and does not get back into the 
windpipe (fig. 188). 


222 


PREVENTION OF DISEASE AND CARE OF SICK. 


In case a patient who has shock is found to be bleeding freely, 
the first indication is to stop the hemorrhage, and this must be done 
regardless of his condition, as there is no hope of recovery as long as 
the loss of blood continues. For methods of checking hemorrhage, 
see page 204. 

BANDAGES AND BANDAGING. 

Bandages are used to hold dressings on wounds or other injuries, 
to keep splints in place, to hold the extremities in various positions, 
and to apply pressure to different parts of the body. 

Bandages are generally made of muslin or gauze. There are 
three principal varieties of bandages in common use, the roller 
bandage, triangular bandage, and the many-tailed bandage. 

ROLLER BANDAGE. 

These bandages are composed of long, narrow strips of muslin 
or gauze. The gauze roller bandage is the better because it has 
considerable elasticity and is easier to fit to the part. The use of 
roller bandages requires some training and considerable practice. 
It is not difficult, however, to apply a roller bandage to the finger, 
wrist, or the knee joint. 

Roller bandages come in different widths, and if satisfactory 
results are desired the proper width must be used for the part to 
which it is applied. For example, a bandage about three-quarters 
of an inch wide is most suitable for the finger. For the hand the 
bandage should be about an inch and a half wide; for the wrist or 
arm 2 to 2-J inches wide; for the thigh and body a 4-inch roller is 
most convenient. The length of the bandage depends to a certain 
extent on its width, ranging from a yard for finger bandages up to 
10 yards for the bandages intended for the body or thigh. Short 
roller bandages are of very little practical use. A strip of wide 
roller bandage, that is, 4 or 6 inches, makes an excellent sling, and 
similar strips of bandage are useful in fastening on splints. 
Properly rolled bandages may be easily cut with a sharp knife 
into any width desired. Narrow strips of adhesive plaster applied 
from the top to the bottom of the bandage will greatly help in 
keeping it from being disarranged. 

METHOD OF APPLYING ROLLER BANDAGES. 

Having selected the proper size, hold the bandage in the right 
hand. Place the free end of the bandage on the part and prevent 
it from slipping with the forefinger or thumb of the left hand. 


PREVENTION" OF DISEASE AND CARE OF SICK. 


223 


The bandage is wrapped around the limb, passing from the opera¬ 
tor's left to right, as it goes across the front. On bandaging the 
trunk or upper parts of the extremities, it is necessary to pass the 
bandage from the right to the left hand in going behind. 

THE SPIRAL REVERSED BANDAGE. 

If the part to be covered is of the same diameter all the way up, 
the bandage is simply wound around the limb or body, each turn 
overlapping the preceding one by about two-thirds of its width. 
This is known as a circular bandage (fig. 189). If the part increases 
in diameter as the bandage ascends, as, for instance, the calf of the 
leg, it is necessary to make a half turn or fold with the bandage at 
each revolution where the limb becomes larger. This is called the 
“ reverse ” and is essential in order to make a snug fit and to prevent 
the bandage from slipping off. To do this the thumb or forefinger 
of the left hand is placed on the bandage in the front of the limb and 
the bandage given a half turn on itself, making it point in a down- 
ward direction instead of upward (fig. 190). The reverse is repeated 
at every turn until the greatest diameter of the limb is passed, when 
ordinary circular turns may again be resumed. The bandage is fas¬ 
tened by pinning the end with a safety pin, covering it with a strip 
of adhesive, or by splitting the bandage for 6 or 8 inches, tying a knot 
in the strips at the beginning of the split and bringing one of the 
split parts around in one direction and the other in the opposite, and 
then tying them (fig. 191). 

Roller bandages should be applied firmly, but neither too tightly 
nor too loosely. If they are too tight, they will shut off the circula¬ 
tion and cause considerable pain. If they are too loose, they very 
quickly come off or will permit the dressing to be displaced from the 
wound. In using a roller bandage the ends of the fingers or toes 
should always be left out of the bandage, so that the operator can 
see if the circulation has been stopped. To test this matter press 
against the toe for a moment with the operator’s forefinger and then 
take the finger away quickly. This will leave a white spot, and if 
this spot quickly becomes red again the circulation is all right. If 
the color returns very slowly, the circulation has been interfered with 
and the bandage should be reapplied. 

FIGURE-OF-EIGHT BANDAGE. 

In applying a circular bandage about the knee or other joint it will 
be found very easy to use it in this manner. Three or four turns of 
the bandage are made below the joint and then a turn is made above, 
then another turn below and a turn above. These are alternated 


224 


PREVENTION OF DISEASE AND CARE OF SICK 




Fig. 193 .—l igure of eight of the knee completed. (From Foote’s Minor Surgery, Comv 

tesy D. Appleton & Co.) 


Fig. 192.—Figure of eight of the knee, spiral turn in place. (From Foote 

gery, Courtesy D. Appleton & Co.) 


s Minor Sur* 











Fig. 195.— Bandage of the finger, (From 
Fowler's Surgery. Courtesy W. B. 
Saunders Co.) 


Fig. 196.—Bandage of the toe. (From 
Fowler’s Surgery. Courtesy W. B. 
Saunders Co.) 



Fig. 19S.—Bandage of the wrist, forearm, 
and elbow. (From Fowler’s Surgery. 
Courtesy W. B. Saunders Co.) 


Fig. 199.—Ascending spica of the groin. 
(From Fowler’s Surgery. Courtesy 
\V. B. Saunders Co.) 


















Pig. 204.—Modified Barton’s bandage for lower 
jaw. (From Fowler’s Surgery. Courtesy 
W. B. Saunders Co.) 


Fig. 205.—Triangular bandage of the groin. 
From Fowler’s Surgery. Courtesy W. B. 
aunders Co.) 



Fig. 206.—Spiral bandage of the chest. 
(From Fowler’s Surgery. Courtesy 
W. B. Saunders Co.) 



Fig. 210.—Method of enveloping hand in a trian¬ 
gular bandage, step one. 



Fig. 211.—Method of enveloping hand in a tri¬ 
angular bandage, step two. 























PREVENTION OF DISEASE AND CARE OF SICK. 


225 




until the whole joint is completely covered (figs. 192 and 193). This 
bandage fits neatly and is hard to displace. 

In bandaging the fingers or hands three or 
four turns are generally made first around the 
wrist to gain a point of support and then the 

bandage run to the fin¬ 
gers or palm of the 
hand,* as the case may 
be. At the finish it is 
again run to the wrist 
and given an additional 
turn or two. This 
keeps the bandage from 
slipping off (fig. 195). 


In bandaging the 


Fig. 


-Bandaging 

foot. 


the 


foot or toes, it is al¬ 
ways best to begin at the ankle, making sev¬ 
eral turns, and then to work down to the 
part which it is desired to cover (fig. 196). 
In bandaging the foot and leg the ends of 
the toes must be always left exposed. The 
pressure of the bandage should always be greater at the bottom and 
gradually decreased as it goes up the leg. 


Fig. 200.—First step, figure 
of eight of the calf. 



Fig. 201.—Second step, fig¬ 
ure of eight of the calf. 


THE RECURRENT 
BANDAGE. 

When it is necessaiy to 
cover the end of a finger or 
stump, several circular turns 
are made at the base, and 
then the bandage is led back¬ 
ward and forward from the 
base over the end, the loops 
being held by the fingers 
until they are secured by 
regular spiral turns (figs. 
207 and 208). 

The great objection to the 
roller bandage in first-aid 
work is the practice required 


to apply it so that it will remain in place and also 
the difficultv which is encountered in trying to ob- 
tain these bandages in an emergency. 

Most bandages are difficult to describe in words 
and are better understood from pictures, hence a number of illustra¬ 
tions of the most useful types have been included in this supplement. 


Fig. 202.— Figure of 
eight of the calf, 
completed. 







226 


PREVENTION OF DISEASE AND CARE OF SICK 



Fig. 207.—Recurrent bandage of the fingers. (From Foote’s Minor Surgery, Courtesy 

D. Appleton & Co.) 


Pig. 208, Recurrent bandage of the fingers, completed. 

Courtesy D. Appleton & Co. 


(From Foote’s Minor Surgery 

) 












PREVENTION OF DISEASE AND CARE OF SICK. 


227 


THE TRIANGULAR BANDAGE. 

The triangular bandage has been much advocated for emergency 
use and for those who are inexperienced with the roller bandage. 
This bandage, also called the Esmarch’s bandage, comes in the shape 
of a triangle, being about 36 inches long on the short sides and about 
51 inches on the diagonal. Such a bandage makes an excellent sling 
and also a good tourniquet. It can be used to completely envelop a 
hand or foot in the case of a crushing injury (fig. 210). Folded Up 
on itself so as to make a strip about 4 inches wide, it is known as 
the u cravat ” bandage, and is useful for holding dressings in place 
about the head. The various applications of the Esmarch bandage 
can be best understood by a study of the illustrations. 

EXPLANATION OF NUMBERS SHOWN ON FIGURES IN ILLUSTRATION OF ESMARCH 

BANDAGE (fig. 209). 

1. Broken leg below knee and at ankle. Umbrella used as splint. 

2. Broken arm—upper arm and at wrist. Rough wood splints used. 

3. Hand bandage. (See also No. 7.) 

4. Wide sling for arm. 

5. Upper-arm bandage. (See also No. 18.) 

6. Thigh bandage. 

7. Hand bandage. (See also No. 3.) 

8. Eye bandage. 

9. Scalp bandage. 

10. Chin and face bandage. 

11. Knee bandage. 

12. Wrist and forearm bandage. Rough wood splints used. . 

13. Bandage for back. 

14. Elbow bandage. 

15. Foot bandage. 

16. Splint and bandage for broken thigh and ankle. 

17. Splint and bandage for broken leg. 

18. Arm bandage. 

19. Chest bandage, rear view. 

20. Chest bandage, front view. 

21. Skull bandage. 

22. Forehead bandage. 

23. Heel bandage. 

24. Narrow sling for arm. 

26. Forearm bandage. 

29. Throat bandage. 

31. Hip bandage. 

32. Shoulder bandage. 

33. Stopping artery bleeding of arm with hand pressure. 

34. Stopping artery bleeding of arm with tourniquet. 

35. Stopping artery bleeding of leg with hand pressure. 

36. Stopping artery bleeding of leg with tourniquet. 

37. 38. Removing foreign substance from eye. 

The triangle bandage is frequently found in first-aid packets and 
is sometimes covered with pictures illustrating its use. However, 
such bandages are generally stiff and difficult to apply snugly. 

49671°—23-18 



228 


PREVENTION OF DISEASE AND CARE OF SICK. 



FiQ. 209.—Various applications of tbe triangular bandage. 























Fig. 212.—Method of enveloping hand in a 
triangular bandage, step three. 


Fig. 213.—Method of enveloping hand in a 
triangular bandage, step four. 




Fig. 214.—Method of tearing a many- 
tailed bandage. 


Fig. 216.—Many-tailed bandage applied. 



* 

Fig. 215.—Many-tailed bandage, complete. 









































Fig, 219,—Four-tailed bandage of the 
jaw, back view. 





Fig. 221.—T bandage applied, 


Fig. 222.—Dressing fastened to the un¬ 
dershirt, step one. 




















PREVENTION OF DISEASE AND CARE OF SICK. 


229 


THE MANY-TAILED BANDAGE. 

This is probably the most useful all-around bandage for first-aid 
'work, because it can be applied by anyone who has once seen it used 
and can be improvised out of materials which are generally at hand. 
The many-tailed bandage is simply a series of strips of muslin which 
are tied around the limb, but instead of being entirely separated are 
left attached to each other at their middle. This attachment serves 
to hold them in place and to keep the bandage in position. 

To make a many-tailed bandage, take a strip of cloth long enough 
to go completely around the limb and dressing and provide ends 
which can be tied. The ends are folded together and notched with 
scissors or a knife at intervals of about an inch and a half. The 



cloth is torn at these points almost to the fold but not quite (fig. 214). 
The bandage is applied by la} 7 ing it under the limb, straightening 
out the tails, and tying each tail with its fellow over the dressing in 
front of the limb (fig. 216). For neatness the loose ends, after they 
are tied, may be placed under the next one as they are fastened, 
thus giving the dressing a better appearance. Such a bandage can 
be easily loosened or tightened as occasion demands, and it can be 
removed and the dressing changed and the bandage used over again. 
It can be applied to any part of the body and holds its position well. 
It should be made out of muslin, old sheeting being excellent for this 
purpose. 

THE FOUR-TAILED BANDAGE. 

The four-tailed bandage is merely a variety of the many-tailed 
bandage. It is made of a piece of muslin 5 to 8 inches wide and 










230 


PREVENTION OF DISEASE AND CARE OF SICK. 


about three feet long. It is torn down the middle from each end, 
leaving a strip about four inches long which is undivided. For 
illustration and instructions for use of this bandage, see figures 
217 and 218. Triangular and many-tailed bandages are fastened 
by knotting the ends or pinning them. 

THE T-BANDAGE. 

This is made by taking a strip of cloth 4 inches wide and long 
enough to tie comfortably about the waist. Another piece of cloth 
about 3 inches wide, but 5 feet long, is doubled and the double end 
sewed or fastened with a safety pin to the middle of the first strip 
(fig. 220). This bandage is sometimes known as the “crutch” 

bandage and is much used for holding 
dressings on the region around the anus 
or genital organs. The bandage is ap¬ 
plied by placing the first strip around 
the waist and tying or pinning. The 
double strips are then brought forward 
between the legs and pinned or tied to 
the first strip (fig. 221). 

IMPROVISED BANDAGES. 

There are certain parts of the body, 
such as the arm pit, back, and groin, on 
which it is difficult to retain a dressing. 
Frequently dressings or compresses can 
be held in these locations very satis¬ 
factorily by pinning them fast to the 
shirt and then taking up the slack in the 
underwear by pins on the other side of 
the body. 

For applying a dressing to the back in 
this fashion the patient should be turned 
onto the abdomen, the undershirt rolled 
well up, so as to completely expose the area which it is desired to 
cover, and the dressings properly applied (fig. 222). The upper edge 
of the dressing is then pinned to the shirt with two or more safety 
pins, the shirt is rolled down over the dressing and pinned to the 
dressing at the bottom. The patient is gently turned on his side, hold¬ 
ing the dressing in place while this is done, and the slack taken up by 
pinning the foldsiin the front part of the undershirt (fig. 223). The 
same method can also be applied for dressings on the chest or abdo¬ 
men. It may be necessary to pin strips on the lower part of the 
tail of the shirt behind and bring them forward between the legs 
and up to the groin in order to keep the garment from working 
upward. 



Fig. 228.—Showing method of 
holding down a dressing on the 
chest or abdomen by straps 
passing between the legs. 


















Fig. 223.—Dressing fastened to the under¬ 
shirt, complete. 


Fig. 224.—Dressing held in place with 
a stocking, step one. 




Fig. 225.—Stocking dressing, complete. Fig. 226.—Dressing held in place by head cap. 


























FlG, 227 ,—Dressing held in place by head 
cap, side view. 


Fig. 231.—Showing method of stiffening handker¬ 
chief with a piece of cardboard folded in the 
center to hold dressing in proper position on the 
back of the neck. The dressing is pinned to the 
upper part of the cardboard. 




Fig. 232.—Method of applying a sling Fig. 233.—Applying sling, second step, 

made out of a triangular-shaped piece 
of muslin or a triangular bandage. 
























PREVENTION OF DISEASE AND CARE OF SICK. 


231 


A dressing can be quite satisfactorily held in place on the foot or 
leg by a stocking. The stocking should be rolled up and unrolled 
over the dressing as it ascends the leg (fig. 224). Pieces of stocking 
legs make an excellent temporary means of holding dressings on the 
arm also in emergencies. Dressings can be held on the head of chil¬ 
dren or restless people by making a cap to cover the entire head, with 
strings to tie under the jaws. The dressing is fastened to the cap at 
the appropriate place. 




Fig. 230.—Many-tailed bandage of the ab- Fig. 229.—Many-tailed bandage of the ab¬ 
domen. (From Foote’s Minor Surgery— domen. (From Foote’s Minor Surgery— 

Courtesy D. Appleton & Co.) Courtesy D. Appleton & Co.) 

Dressings may be retained on the lower part of the abdomen by 
means of a towel to which strips have been pinned and passed under 
the legs running from behind forward in order to prevent it from 
riding up (fig. 228). 

A many-tailed bandage makes an excellent application for dress¬ 
ings of the lower part of the abdomen. The tails are brought across 
the abdomen diagonally and placed one over the other, pinned down 
the middle, and not tied. In all abdominal bandages bands must be 
run from behind forward between the legs and pinned in front to 
hold the bandage in place (fig. 230). 















232 


PREVENTION OF DISEASE AND CARE OF SICK. 


Dressings to the back of the neck are frequently required, especially 
for boils which are apt to occur in that situation. Such a dreasing 
can be easily held in place by knotting a folded handkerchief around 
the neck, but there is a tendency for the handkerchief to permit the 
dressing to drop too low. To avoid this a piece of cardboard about 
3 inches long and 2-J inches high should be folded in the center of the 
handkerchief and the upper part of the dressing pinned to this 
(%-231). 

PLASTERS. 

Court-plaster or adhesive plaster should never be applied directly 
over a wound. Such plasters generally contain germs, and they seal 
the wound up, preventing the escape of fluid, and causing conditions 
which greatly favor the multiplication and growth of bacteria. It 
is permissible to hold a small dressing of gauze in position over a 
wound by means of a strip of adhesive plaster, as, for instance, on 
wounds somewhere about the face, but the plaster should never touch 
the wound directly and there should be enough gauze under it to 
take up any discharges which may seep out of the injury (fig. 236). 

In a great emergency where a physician is not available to treat a 
large, gaping wound it may be necessary to pull the edges of the 
wound together with strips of adhesive plaster. If this is done the 
plaster should be in narrow strips and wide intervals left between 
for the escape of secretions from the wound. A method of cutting 
these strips so that the interference with the drainage is reduced to 
the lowest possible point is shown in figure 237. 

Strips of adhesive plaster are often useful in place of bandages in 
holding large dressings in place on the abdomen, groin, hip, or other 
localities where the inexperience of the operator makes it difficult 
to apply a bandage. 

Before applying strips of plaster in this fashion the skin should 
be shaved if it is very hairy. Adhesive plaster may be removed with¬ 
out pain by wetting it in gasoline or ether. If the plaster has ex¬ 
coriated the skin, the raw places should be bathed with dilute alcohol, 
thoroughly dried, and dusted with boric-acid powder. If the dress¬ 
ing has to be reapplied, the strips of plaster should be so arranged 
as to come on a new surface where the skin has not been irritated. 
In using adhesive plaster as a means to retain dressings on the legs 
or arms, care must be taken that the strips do not completely encircle 
the limb, because if they do they may shut off the circulation and 
cause considerable injury. 




Fig. 234.—Showing pad on the back of the Fig. 235.—Emergency sling made of two 

neck to prevent pressure from sling on handkerchiefs, 

the neck. 



Fig. 236.—Pressing held on with adhesive 
plaster. 


Fig. 237.—Wound closed with adhesive 
piaster. (Not recommended. To be 
used only in great emergency.) 
























Fig. 238.—Cold compress applied to the knee. (Note the thickness 

and extent of compress.) 



Fig. 239.—Cold compress covered with oiled paper. 



Fi< 3. 240.—Compress fastened in place with many-tailed bandage and 
on pillow protected with oilcloth. 















PREVENTION OF DISEASE AND CARE OF SICK. 


233 




MISCELLANEOUS MINOR INJURIES AND HERNIA. 

BRUISE. 

Desorption .—A bruise is the injury produced by a blow with some 
blunt object. Bruises are received in two ways—the body may be 
still and the object moving, as when a boy is struck by a thrown 
baseball, or the body may be moving and strike against some fixed 
object, as when a man falls and injures himself on a hard pavement. 
Bruises are the commonest of all accidents, and everyone has at some 
time suffered from them. 

Symptoms .—The first symptoms of a bruise is pain; then the in¬ 
jured part quickly becomes red and slightly swollen. If the bruise 
is severe, the skin over it becomes black and blue after some hours. 

Treatment .—If the injury is slight, no treatment is required. If 
more severe, cold-w^ater compress should be applied. To make a 
cold-water compress take from 6 to 10 folds of old muslin, linen, or 
such material (a couple of thicknesses of turkish toweling makes an 
excellent compress). The dressing should be large enough to cover 
the injured surface and extend a couple of inches beyond, and should 
be thick enough to retain the moisture for some time. It is wrung 
out in cold water and then laid on the seat of the injury. Some cov¬ 
ering will be required to prevent the dressing from becoming dry, 
and also to protect the clothing or bed. The most available material 
for this purpose is oiled paper. In an emergency an old piece of oil 
cloth or any flexible waterproof material will do very well. This is 
put outside of the compress and the whole held in place by a bandage 
of some sort. The compress may be continued for three or four days, 
after which rubbing the injured part twice a day with a mixture of 
equal parts of alcohol and water or undiluted whisky will help to 
take out the soreness. 

BLACK EYE. 

A black eye is merely one form of a bruise. As soon as a blow is 
received in this region a handkerchief wrung out in ice water should 
be applied. The ice water should be renewed as often as it gets 
warm, thus combining the effect of both cold and moisture. This 
treatment should be kept up from half an hour to an hour and may 
prevent discoloration from setting in. 

If treatment is begun after the flesh has become black, hot-water 
applications for half an hour, three times a day, will hasten the dis¬ 
appearance of the swelling and discoloration. The old-fashioned 
practice of applying raw beefsteak is not recommended. In all cases 
where a severe blow has been received in the region of the eye a 
physician should be consulted, as there is danger that injury may 
have been done to the eyeball. 


284 


PREVENTION OF DISEASE AND CARE OF SICK. 


BRUISES WITH WOUNDS OF THE SKIN. 

If the skin is cut or torn when a bruise has been received the injury 
becomes a lacerated wound and should be treated as directed on 
page 191. 

STRAINS. 

Description .—Strains are the injuries produced bv overstretching 
a muscle. The muscle, in severe cases, may be partially torn or even 
ruptured. The muscles of the back, shoulder, and wrists are often 
the seat of strains. A sudden wrench or too great exertion fre¬ 
quently causes a strain. 

Symptoms .—Pain which is increased when the part is moved, sore¬ 
ness and more or less swelling. 

Treatment .—Rest, with gentle rubbing with alcohol and water, 
equal parts; tincture of arnica or soap liniment. Later on the rub¬ 
bing should be more vigorous with gentle kneading of the muscles 
affected. The application of dry heat by means of hot-water bags 
or bags filled with hot sand will often give relief from pain and help 
to “ limber up ” the part. 

STRAINED OR LAME BACK. 

This is a very common and distressing condition. It is not always 
a true sprain, being sometimes due to muscular rheumatism. 

Symptoms .—Pain in the lower part of the back or region of the 
loins which is worse when the patient attempts to get up or sit down, 
but not so severe when standing, and may entirely disappear on lying 
down. 

Treatment .—That part of the back which is the seat of the trouble 
should be completely incased in several layers of surgeon's adhesive 
plaster, so as to form a sort of jacket. The use of the plaster in this 
way keeps the muscles at rest and gives support. 

To apply the dressing, the patient is seated on a stool, all the cloth¬ 
ing having been removed from the back, abdomen, and hips. The 
plaster comes in various widths, which are wound on spools and may 
be obtained at most drug stores. A 24-inch spool should be selected 
for this purpose and cut in lengths long enough to cover the back 
and extend well forward along the sides—about 18 inches for persons 
of ordinary girth. The strips are applied firmly to the back and 
sides, overlapping each other for about an inch along their entire 
length (fig. 241). 

At least three thicknesses of the plaster should be used so as to give 
good support. The dressing may be worn from two to three weeks 
or longer. 

If there is any suspicion of rheumatism, the patient should be 
purged for four days and a teaspoonful of baking soda taken in half 


Fig. 241.—Method of strapping the back 
with adhesive plaster. 


Fig. 242.—Eversion of the upper lid, step 
one. 






Fig. 243.—Eversion of the upper lid, step 
two. 


Fig. 244.—Improvised eye dropper. 




















Fig. 215.—Correct method of putting 
drops in the eye. 


Fig. 246.—Method of wringing out a hot compress 
in a towel to avoid burning the hands. 



Fig. 247.— Dislocation of the lower jaw. Fig. 248.— Reduction of dislocation of 

(From Seudder’s Fractures. Courtesy lower jaw. 

W. B. Saunders Co.) 



















PREVENTION OF DISEASE AND CARE OF SICK. 


235 


a glass of water just before retiring for at least two weeks. Acid 
fruits, especially oranges and grapefruit, should be avoided and 
plenty of w T ater drunk. 

FOREIGN BODIES IN THE EYE. 

Foreign bodies in the eye come under two classes, first those which 
lodge under the lids and second those which are firmly adherent to 
the clear part of the eyeball, the cornea, sometimes known as the sight 
of the eye. 

Treatment. —To remove a foreign body from under the lid, first of 
all determine which lid is affected. To do this, seat the patient on a 
chair facing a window and pull the lower eyelid down, having the 
patient look up. If a cinder or other speck is seen, take a clean pocket 
handkerchief, folded so that it makes a point, and remove the object 
with the point. Wetting the tip of the handkerchief with clean water 
will sometimes assist the process of removal. 

If nothing is seen on the lower lid, it will be necessary to invert 
the upper lid. To do this take a match, lay it across the lid, holding 
it in one hand, grasp the eyelashes with the fingers of the other hand, 
have the patient look down and turn the lid upside down by pulling 
the lashes up over the match. The lid may be held in this position 
by the left hand and the foreign body removed with the handkerchief 
as described above. If it is very firmly embedded, a clean toothpick 
may be used to loosen it from the flesh. 

Removal of foreign bodies which are lodged on the cornea or sight 
of the eye .—This is sometimes very difficult, as particles of steel are 
frequently firmly embedded in the eye in this locality. It may be 
difficult to see them, and a magnifying glass may be necessary for 
this £>urpose. Sometimes their presence can be detected by the fact 
that a few enlarged blood vessels run toward the foreign substance. 
After the object is seen a very small particle of cotton may be 
firmly wrapped around the point of a clean toothpick and moistened 
with clean water. It may be possible, by having the patient look 
steadily at some object, to hold the lids apart and remove the for¬ 
eign body in this way. Frequently, however, it will be too firmly 
embedded to be extracted by this procedure. Such cases require the 
services of a physician. Pending the arrival of a doctor, both eyes 
should be closed, small pads of cotton placed over them and a hand¬ 
kerchief tied over the eyes and around the head. This limits the 
motion of the eyeball and prevents further damage. 

If the services of a doctor can not be obtained, put a drop of a 2 
per cent solution of cocaine hydrochlorate in the eye. Wait for 15 
minutes and then place the patient on his back on a c-ouch or table. 
A large needle should be passed several times through a flame and 

40071 0 —23-10+20 



236 


PREVENTION OF DISEASE AND CARE OF SICK. 


cooled. Endeavor to remove the foreign body from the cornea by 
carefully lifting it lip with the needle. The operator should steady 
his hand by resting it on the patient’s face. The cocaine makes the 
eye insensitive, so that the patient does not wink or move when the 
eyeball is touched. 

After a foreign body has been removed from the eye it is well to 
wash the eye out with a saturated solution of boric acid. This may 
be made by adding a teaspoonful of boric-acid powder to a glass of 
warm water and stirring until it is dissolved. The solution should 
be allowed to cool and then one or two drops placed in the eye. If 
an eye dropper is not available one can be improvised by twisting a 
small piece of cotton into the shape of a cigar butt, pulling out the 
small end so that it comes to a fine point (fig. 244). The hands of 
the operator should be washed and then the cotton dipped in boric 
acid, and bysqueezing the blunt end a drop may be caused to run off 
of the fine end into the eye. 

Dropping medicine in the eye. —Very few people understand the 
proper method of putting drops into the eye. This of course is best 
accomplished by using an eye dropper. Only a very small quantity 
of the medicine should be drawn in the dropper, the bulb being very 
lightly squeezed. The patient should sit on a chair facing a fairly 
good light. The dropper should always be held with the point down 
in the right hand of the operator. Stand in front of the patient, pull 
down the lower lid, and have the patient look away from the oper¬ 
ator and then place 1 or 2 drops on the outer edge of the lower lid. 
This will run across the eye and wash off the entire surface. The 
object of the procedure is to have the patient look away and to put 
the drops not on the eyeball but on the junction of the eyeball and 
lid (fig. 245). If the patient sees the drop coming he will involun¬ 
tarily close the lids and the medicine will not get into the eye. 

If the patient is alone when the foreign body flies into the eye, 
ne may try to remove it himself with the aid of a mirror. If a 
mirror is not at hand, and the object is under the upper lid, it can 
sometimes be dislodged by pulling the upper lid down over the lower. 
In any event, the eye should not be rubbed, as this does no good and 
only embeds the object more firmly in the tissues. 

Note.— Blowing the nose is frequently recommended, but I have 
never succeeded in removing a cinder from my own eye in this way 
and I know of no good reason why this maneuver should be effective. 

FOREIGN BODIES IN THE NOSE. 

Children occasionally slip beans and other similar objects into 
the nose. The bean may swell, making an effort to dislodge it par¬ 
ticularly difficult. Sometimes these bodies may be removed by clos¬ 
ing the other side of the nose and having the child blow the nose 


PREVENTION OF DISEASE AND CARE OF SICK. 


2 37 


vigorously. Another device worthy of trial is to cause the child 
to sneeze by tickling the nose with a feather. Occasionally, if the 
object is readily seen, an attempt to remove it may be made by bend¬ 
ing a hairpin slightly and attempting to insert the curved end 
alongside the object, holding the points in the fingers. These cases 
generally require the services of a physician, and they should always 
be taken to a doctor in case the simple treatment above described is 
not successful. 

FOREIGN BODIES IN THE EAR. 

Various foreign bodies are occasionally introduced into the ears 
and may be the source of a great deal of discomfort and pain. An 
insect in the ear may be removed by turning the head to one side 
and filling the ear with warm sweet oil poured into it by means of a 
spoon. The oil will suffocate the insect and it will float out. For 
the removal of other objects a physician should in all cases be em¬ 
ployed, as a great deal of harm can be done by inserting sharp 
instruments into this cavity. Occasionally a small object may be 
. removed by a gentle syringing with warm water. 

FOREIGN BODIES IN THE THROAT. 

The beginning of the throat is known as the pharynx. Lower 
down there are two passages, one of which leads to the stomach, 
called the gullet or esophagus. The other leads to the lungs, and is 
known as the larynx at the upper end, lower down the windpipe or 
trachea. Foreign bodies may lodge in any of these passageways. 
Commonly such objects are articles of food, but other things which 
have been held in the mouth—like coins, safety^ pins, or marbles—may 
accidentally slip back and lodge in the throat. Young children are 
especially apt to put any small articles which they get into* their 
hands into their mouths, and occasionally they attempt to swallow 
them, with disastrous results. 

Foreign bodies in the 'pharynx .—Large foreign bodies in the 
pharynx cause great interference with breathing. They can gen¬ 
erally be removed by opening the mouth and pulling the object for¬ 
ward by means of the fingers or by hooking the index finger behind it. 

Treatment .—Place the patient on a chair facing the light, open 
the mouth, and hold the tongue down with the handle of a tea¬ 
spoon. It may be possible in this way to see the object and to extract 
it. Inversion can be tried in the case of a child and the same effect 
produced in an adult by having him lie crosswise on a bed on his 
abdomen with his head and shoulders hanging over the side. Fail¬ 
ing to remove the obstruction in this way, send for a doctor at once. 

Foreign bodies in the gullet — Symptoms .—When an object lodges 


238 


PREVENTION OF DISEASE AND CARE OF SICK. 


in the gullet the patient has pain, difficulty in swallowing, and breath¬ 
ing may be interfered with. Occasionally the symptoms may be 
slight, but more often the object produces inflammation. 

Treatment .—The treatment is the same as advised for foreign 
bodies in the pharynx. 

Note. —If a child or adult has swallowed some sharp or pointed 
article like a piece of broken glass or a pin, give him a diet composed 
largely of mashed potatoes and bread. Encourage him to eat as 
much as possible of these articles for several days. They will sur¬ 
round the foreign body in large masses and prevent it from injuring 
the walls of the intestine. Do not give purgatives at once, but after 
the bread-and-potato diet has been taken for two or three days a mild 
laxative may be given. Watch the passages carefully for several 
days to be certain that the object has been passed. Such cases should 
always be under the care of a doctor when he is available. 

Foreign bodies in the larynx — Symptoms .—When a foreign body 
enters the upper part of the windpipe it immediately sets up a violent 
attack of coughing which frequently results in its expulsion. A small 
article may, however, remain in the windpipe and gradually work its 
way lower to some point in the lung where it remains permanently, 
causing a continual inflammation characterized by cough, with foul 
and blood-streaked expectoration. If the object is large it may con- 
pletely close the passage and prevent the entrance of air to the lungs 
and threaten death by suffocation. In such cases a patient becomes 
black in the face and makes frantic struggles to secure air. 

Treatment .—If the patient is a child, he should be picked up by the 
feet and held suspended with the head downward, which may cause 
the object to fall out by its own weight. Failing in this, if the symp¬ 
toms are not alarming, endeavor to quiet the sufferer and send for a 
doctor at once. 

RUPTURE OR HERNIA. 

Rupture is due to a weakening of some part of the abdominal walls 
and the escape through the opening of some of the contents of the 
abdomen, usually a part of the bowel. The bowel, of course, is cov¬ 
ered by the skin and some of the other tissues, but forms a larger or 
smaller swelling at the point of the hernia. The commonest form 
of hernia occurs at the groin. Hernias in this location frequently 
can be reduced by the patient when he lies upon his back and properly 
manipulates the mass. 

All persons with weak abdominal walls are liable to hernia, espe¬ 
cially elderly people. The direct cause of the hernia is often the 
strain produced by lifting heavy weights. 

Symptoms .—A painful swelling appears in the groin which may 
disappear when the patient lies down and presses the mass upward 


PREVENTION OF DISEASE AND CARE OF SICK. 


239 


and backward into the abdomen. If the fingers are held in contact 
with the hernia and the patient gives a cough, a sharp impulse will 
be felt by the examining finger at the moment of the cough. 

STRANGULATED HERNIA. 

The great danger of hernia is that the prolapsed bowel may be 
caught in the opening through which it has escaped in the abdominal 
wall, and the swelling which takes place causes an increase in the 
size of the tissues, which finally result in the blood supply being shut 
off and the prolapsed part of the bowel becomes first inflamed and 
then gangrenous. 

Symptoms .—Pain at the seat of the hernia and also in the abdo¬ 
men. The mass can not be replaced and is tender to the touch. There 
is vomiting, which at first is of the ordinary type but later foul smell¬ 
ing, and in odor and appearance resembles the ordinary passages 
from the bowels. ThS pulse is rapid and weak and there is great 
thirst. There are no stools or passages of gas from the anus. 

Treatment .—Place the patient in bed and raise the knees on several 
pillows. Endeavor to return the mass into the abdomen by gentle 
manipulation, trying to push the part that descended last back first. 
This maneuver may be assisted by raising the toot of the bed and 
placing a pillow under the hips so that that part of the body is 
higher than the chest. Prolonged efforts to return the bowel are 
dangerous, and if gentle attempts do not succeed, no further manipu¬ 
lation should be tried but a doctor should be sent for immediately. 
Pending the arrival of the doctor do not permit the patient to take 
any food. 

If the bowel cai; be reduced by the above manipulation, keep the 
patient in bed for several davs and allow only water for the first 24 
hours, gradually permitting small quantities of soft food as time 
goes on. 

If it is certain that a doctor can not be obtained, an ice bag may be 
applied to the hernia in the hope that this treatment may reduce the 
inflammation sufficiently to permit the bowel to slip back into the 
abdomen. If the desired result is not obtained at the end of several 
hours, remove the ice bag. 

Prevention of strangulated hernia .—Operations on hernia nowa¬ 
days are very successful. It is advisable that all men who have her¬ 
nias, and whose occupations require that they go on long sea voyages 
or into the woods or other places where they will be out of reach of 
competent medical help, should be operated on in order to get rid of 
the rupture and escape the dangers of possible strangulation in some 
remote district where suitable treatment can not be obtained. 


240 


PREVENTION OF DISEASE AND CARE OF SICK. 


INJURIES TO JOINTS. 

JOINTS. 

Description .—Wherever two or more bones come together they 
form a joint. The joint is surrounded by a closed sac called the 
joint capsule. This sac contains a slippery fluid, which serves to 
lubricate the joint and permits the bones to move smoothly. The 
joint capsule is not sufficiently strong to prevent the bones from being 
torn apart, so additional strength is furnished co the joint by strong 
bands of tissue, which are known as ligaments. It will be noted 
that some joints, such as those in the fingers, move only backward 
and forward, while other joints, as, for example, the hip joint, will 
permit of movement in practically all directions. 

SPRAINS. 

Description .—Sprains are the injuries produced by wrenching or 
twisting a joint. Sprains of the ankle, wrist, shoulder, and knee 
are very common. Severe sprains should always be treated by a 
doctor, if possible. There was an old saying that bad sprains were 
worse than fractures. As a matter of fact, many of these u sprains ” 
were in reality small or partial fractures near the joint, especially 
when involving the ankle. In severe sprains of the shoulder, wrist, 
or ankle an X-ray examination of the affected part should always 
be made if it is possible to do so. Sprains of the ankle in which 
extensive areas of black and blue skin are observed, extending for 
a considerable distance up the leg, are almost always accompanied 
by fractures. 

Symptoms .—Severe pain, always increased by motion of the joint, 
and hence there is often apparent lack of ability to move the limb. 
Swelling and sometimes redness, later on possibly discoloration. 

Treatment .—Absolute rest to the joint. If at the wrist or shoulder, 
put the arm in a sling. If a knee or ankle is involved, put the 
patient in bed and rest the joint on a pillow. Apply cold water 
compresses, using a thick dressing large enough to wrap completely 
around the joint and extend well above and below it. Hot-water com¬ 
presses may be used if more agreeable to the patient. Continue the 
compresses until the pain and swelling subside. This may require 
from two to five days. Then cautiously begin rubbing with alcohol 
diluted with an equal amount of water or tincture of arnica. Later, 
in addition to the rubbing, which should become gradually more 
vigorous, begin gently moving the joints by grasping the hand or 
foot and moving it in various directions. These motions should be 
made by the operator and not by the patient. The injured person 


PREVENTION OF DISEASE AND CARE OF SICK. 


241 


should exercise great caution in beginning to use the part. In recent 
years severe sprains and strains which resisted ordinary treatment 
have sometimes been greatly benefited by being baked in dry air 
at a very high temperature. This treatment, however, requires 
special apparatus and skilled supervision, hence is not available for 
home use. 

Sprains of the ankle joint are often treated by strapping with 
adhesive plaster. Cold compresses should be used for four or five 
days, and when the swelling is somewhat reduced the plaster may 
be applied. For this purpose take strips about an inch wide and 
apply them snugly to the sides of the ankle running around the 
heel and to the sides of the foot encircling the heel. The method of 
application can be best understood from studying figure 311. Be 
sure, however, to leave a strip of skin which is not covered by the 
plaster extending all the way up the front of the foot and ankle. 
The whole limb must not be encircled by the plaster. Plaster applied 
in this fashion makes in reality a flexible splint and gives considerable 
support to the joint. It can be worn for three or four weeks if 
necessary. 

Physicians very frequentty use plaster of Paris casts in the treat¬ 
ment of severe sprains. In the case of the ankle, the joint should 
be thoroughly protected by some resilient material such as a woolen 
bandage, a smoothly applied layer of cotton batting, or a couple of 
thicknesses of cotton stocking. The cast is applied from just behind 
the toes to a little above the middle of the calf. Great care should 
be taken in putting the cast on that the circulation is not obstructed, 
and the toes should be frequently examined in order to be certain of 
this point. If pain follows the application of the cast, or the toes 
become blue or dark, the cast should be immediately removed. 

DISLOCATIONS. 

Description .—When one of the bones is forced out of its proper 
place in a joint and remains permanently out, the injury is known 
as a dislocation. These accidents tear or stretch the ligaments, and 
even if properly treated the joint is apt to be weak afterwards and 
will slip out of place more easily a second time. The' shoulder joint 
is more frequently dislocated than any other joint in the body. 

Causes .—Dislocations are usually the result of falls or severe 
accidents. 

Symptoms. —Pain, inability to move the joint in the usual manner, 
the appearance of the joint differs from the sound one on the other 
side, the end of the displaced bone may be felt to be in an improper 
position when compared with its uninjured fellow, and swelling may 
occur shortly after the injury has been received, 


242 


PREVENTION OF DISEASE AND CARE OF SICK. 


First-aid treatment. —Always send for a physician if one is avail¬ 
able. Pending his arrival apply cold water compresses to the joint 
and put the part at rest by placing the arm in a sling if it is in the 
upper extremity or by having the patient lie down and rest the in¬ 
jured member on a pillow if the accident has happened to the lower 
extremity. This is all that need be done until the arrival of the sur¬ 
geon under ordinary circumstances. It is difficult to reduce most 
dislocations, and considerable harm may be done by inexperienced 
persons in their attempts to do so. 

There are two joints, however, which are very often successfully 
treated by the laity’ when dislocated and in which attempts at dislo¬ 
cation are not accompanied b}^ danger. These are dislocations of the 
lower jaw and finger. 

D islocation of the fingers .—Dislocation of the fingers often occur 
from the results of injuries received in playing baseball. 

Treatment .—The dislocated finger should be grasped firmly by the 
operator, and the end which is out of place should be pulled straight 
away from the hand. It will then usually slip into place. Cold 
compresses should be applied for a day, and the hand carried in a 
sling to prevent undue swelling and inflammation. 

Note.—D o not attempt to reduce a backward dislocation of the 
thumb at the joint where it joins the hand. 

Dislocation of the lower jaw .—Dislocation of the jaw is not an 
infrequent accident and is sometimes due to opening the mouth too 
widely as in yawning. The patient presents a peculiar appearance, 
the jaw hanging down and the victim being unable to close the 
mouth (fig. 247). Speech, of course, is interfered with. Either side 
of the jaw may be dislocated or both. 

Treatment .—Place the patient in a chair with his head against 
the back. The operator stands behind the patient and places the right 
thumb, wrapped in a towel to protect it from injury, far back in the 
right side of the patient’s mouth and rests it on the back teeth. The 
left hand grasps the chin with the palm upward (see fig. 248). Next 
press the back end of the jaw down with the thumb inside the mouth 
and then the bone can be pushed backward into place by means of 
the left hand on the chin. The hands are reversed and the left side 
treated in the same manner. When the bone goes into place the jaw 
will snap shut with considerable violence, and care must be taken 
to protect the finger which is within the mouth. 

After reduction the jaw should be bandaged (fig. 204) and only 
soft food permitted for several weeks. 

Dislocation of the shoulder. —As has already been stated this is 
the most frequent dislocation in the body. 

Symptoms .—The shoulder on the affected side does not look like 
the other (fig. 249). For making this inspection the patient should 




Fig. 249.—Dislocation of the shoul- Fig. 250. —Reduction of dislocation of the shoulder, step 

der. (From Scudder's Fractures. one. 

Courtesy W. 13. Saunders Co.) 



Fig. 251.— Reduction of dislocation of the shoulder, step 

two. 



Fig. 252.—Reduction of dislocation of the shoulder, step 

three. 


















Fig. 253.—Reduction of dislocation of the shoulder, step 

four. 


Fig. 254.—Emergency dressing for dis¬ 
location of the clavicle; pad under 
arm. 



Fig. 255.—Emergency dressing for dis¬ 
location of the clavicle; arm bound 
down to side. 


Fig. 256.—Emergency dressing for dislo¬ 
cation of the clavicle; sling applied. 




















PREVENTION OF DISEASE AND CARE OF SICK. 243 

be stripped to the waist and seated on a stool, the operator standing 
exactly in front and behind him to compare the two sides. The two 
shoulders should also be gently examined by feeling them with the 
hands. If the hand of the affected arm can be placed on the opposite 
shoulder, and while the hand is in this position the elbow brought 
to the side of the chest, the shoulder is not dislocated. The arm can 
only be moved slightly at the shoulder joint, and such attempts pro¬ 
duce great pain. The patient will usually support the injured mem¬ 
ber with the other hand because the weight of the arm increases the 
pain. 

Treatment .—If a surgeon can be obtained within four hours, make 
no attempt at reduction, but place the patient in a comfortable posi¬ 
tion and apply cold compresses to the shoulder. 

If a doctor can not be secured within four hours it is orenerallv 
proper to attempt to reduce. 

Method of reduction .—Place the patient on the ground or a couch. 
Grasp his wrist with one hand and the elbow with the other. Gradu¬ 
ally bring the elbow against the side and hold it there, then swing 
the wrist forcibly outward with the right hand (fig. 251). Hold it in 
this position and bring the elbow upward and inward across the 
body toward the middle line as far as it will go (fig. 252). Holding 
it in this position swing the forearm inward across to the other side 
of the chest (fig. 253). These motions should be made slowly and 
with deliberation. Considerable patience may be required to over¬ 
come the muscles, which are in a state of spasm on account of the 
irritation due to the injury. 

If an attempt is made to reduce the dislocation, do so immediately, 
as the longer the bone is allowed to remain out of position the more 
difficult it will be to replace it. In case one careful effort does not 
succeed do not attempt further manipulations of this sort, but await 
for qualified surgical aid. Treat the joint with cold compresses as 
directed for sprains. After the bone has been replaced bandage the 
arm to the side with the hand almost on the opposite shoulder 
(fig. 256). Keep it in this position for seven days and then remove 
the bandage and move the arm gently in various directions (passive 
motion). After the motion put the arm in the original position and 
replace the bandage. Perform passive motion every day for a week. 
Then place the arm in a sling, permitting slight voluntary motion. 
After three weeks the patient may begin to use the arm with mod¬ 
eration. 

Dislocation of collar bone or clavicle .—The collar bone runs from 
the breast bone to the shoulder and can be easily felt beneath the 
skin. It may be dislocated at either end. 

Symptoms .—Pain and more or less inability to use the arm. The 
patient may be unable to raise the arm over the head. The dislocated 


244 


PREVENTION OF DISEASE AND CARE OF SICK. 


end of the bone can sometimes be felt in an unnatural position. Com¬ 
pare it with the opposite side. The affected shoulder is lower than 
the other. There is no crepitus. 

First-aid treatment .—Place a pad in the armpit of the injured side 
and hold in place with two strips of muslin going over the opposite 
shoulder. Fasten the arm to the side with a bandage or strips run¬ 
ning around it and the body. Apply a wide sling which supports 
and raises the point of the elbow (fig. 256). 

After treatment .—Remove the clothing to the waist and place the 
patient on a stool. Stand behind him and grasp the shoulders. Place 
the knee against the back between the shoulder blades and draw the 
shoulders backward. Have an assistant at the same time endeavor 



to push the end of the bone into its proper place. Apply a compress 
over the seat of the injury and hold the shoulders back with a figure 
eight bandage to the shoulders (fig. 197). Support the arm and 
elbow with a sling which pulls the point of the elbow upward. If 
possible, keep the patient in bed for three weeks with this dressing 
in place. After three weeks remove the dressing and allow patient 
to get up. Some deformity will almost always follow a dislocation 
of the clavicle, but a useful arm may be expected notwithstanding. 

All other dislocations. —Xo attempt should be made to reduce dis¬ 
locations of other parts than those described except by a physician, 
as great injury may be done by injudicious handling, and it is much 
better to wait even for a number of days until qualified help is ob¬ 
tainable. All these dislocations, however, should be treated with cold 
compresses and the part kept at rest by appropriate measures. 










PREVENTION OF DISEASE AND CARE OF SICK. 


245 


Shock may be present in dislocation of the larger joints, and this 
should be borne in mind and suitable treatment applied if it is 
present. 

FRACTURES. 

The bones constitute the framework of the body and serve to give 
it rigidity and form. They also perform a useful function in pro¬ 
tecting important organs, such as the brain, heart, and lungs. The 
bones are quite strong and are capable of withstanding considerable 
force, but if sufficient stress is applied in the right direction, they will 
first bend a little and then finally break. The bones of children are 
much more elastic than those of adults or o'd persons. 

When a bone does break the fractured pieces are generally sharp 
and jagged (fig. 257). Their rough or pointed ends may do great 
damage to the flesh, especially if the broken limb is moved around 
carelessly. Every effort should therefore be made when fractures 
are received to prevent the sharp edges of the bones from tearing 
the muscles or even coming out through the skin. 

Broken bones are known as fractures and are very common in- 

4 / 

juries. Fractures are generally produced by falls or direct violence, 
such as a squeeze or crush. 

VARIETIES OF FRACTURES. 

When the bone is broken and there is no wound, the injury is known 
as a simple fracture. If the skin is broken and there is a wound lead¬ 
ing down to the ends of the bone, it is called a compound fracture. 
The student should remember that a compound fracture, then, is one 
in which the fracture is compounded by a wound. A compound frac¬ 
ture is not a fracture in which the bone is broken in more than one 
piece without a wound. Such fractures are called comminuted frac¬ 
tures. Briefly, then, a simple fracture is one without a wound, a 
compound fracture is one with a wound. The distinction between 
these two varieties of injury is very important, because, while most 
simple fractures unite without difficulty or grave symptoms, com¬ 
pound fractures, on the other hand, on account of the open wound 
frequently become infected with pus germs. Active suppuration 
follows, which involves the bone, and a long time is required for 
recovery. Hence, compound fractures are very serious injuries and 
may even at times prove fatal. Every effort should therefore be 
made to prevent a simple fracture from becoming compound. As 
above explained, if the patient is carelessly moved, a sharp bit of 
bone, as shown in figure 258, may be easily forced through the flesh 
and skin and the simple fracture be converted into a compound frac¬ 
ture by injudicious handling. To prevent this accident splints or 
some sort of appliance should always be placed around broken bones 
before the sufferer is moved. 


246 


PREVENTION OF DISEASE AND CARE OF SICK. 


SYMPTOMS OF FRACTURE. 

Simple fracture .—There is the history of an injury and the part 
is painful and tender when touched. There is loss of function; that 
is, the part can not be moved to as great an extent as before. All 
attempts at motion produce great pain. There may be visible de¬ 
formity and the limb may be shorter than the uninjured one on the 
other side. It may be possible to feel the break by running the 
fingers along the bone. False motion may be detected; that is, the 
arm or leg bends at a place where there is no joint. It is not safe to 
assume that because a man can move his arm or leg that it is not 
broken. Men have been known to w^alk on a broken leg. 

Crepitus or grating .—This is a peculiar rasping sensation which 
can sometimes be detected in fractures when the ends of the bone are 
slightly moved, somewhat similar to that experienced by rubbing the 
ends of a broken clay-pipe stem together, while holding them in the 
fingers. The grating is felt by the hands'manipulating the bones 
and is rarely heard. Any one of these symptoms, except the pain, 
may be absent. The shortening when it is present is due to the fact 
that the muscles attached to the bone are always under tension, like 
stretched rubber bands, and if the break is complete and the ends free 
to move they will tend to pull the broken pieces by each other, thus 
shortening the limb. 

Impacted fractures .—This name is applied to injuries where the 
broken ends of the bones are driven into each other. Such fractures 
are most common near the heads of larger bones where the bone is 
porous and the broken surfaces extensive in area. Many of the symp¬ 
toms of ordinary fractures are absent in impacted fractures, but 
there is often considerable deformity, especially in impacted frac¬ 
tures at the wrist. 

There are three positive signs of fracture. These are, first of all, 
crepitus; second, unnatural motion, that is, bending where there is 
no joint; and third, shortening. An inexperienced person should 
not deliberately attempt to produce crepitus, but the characteristic 
grating sensation may be felt when one is supporting the part or 
adjusting it on a splint. The grating sometimes felt in moving a 
joint must not be mistaken for the crepitus of a fracture. It may be 
impossible to tell whether false motion is present or not if the break 
is near a joint. Finally, shortening may be deceptive because this 
also occurs in certain dislocations, hence great care must be exer¬ 
cised in determining that the shortening is in the bone itself and not 
a shortening of the limb due to the escape of the head of a bone from 
its socket. 

In case a man has received an injury and fracture is suspected, 
there being great pain, more or less loss of motion, possibly numb- 


PREVENTION' OF DISEASE AND CARE OF SICK. 


247 


ness in the fingers or toes, it is always wiser in first-aid work to 
assume that there is a fracture present and treat the case accordingly 
until medical help is available. Splints can be improvised almost 
anywhere and it will do no harm to put the injured member on a 
splint and take the patient to a physician even if there is actually 
no fracture, whereas if there is a fracture and this precaution is 
omitted great damage may result, because an unprotected simple 
fracture may be converted into a compound one during the journey. 

X-rays .—The application of X-ray pictures as a guide to the treat¬ 
ment of fractures has been a most important advance in medicine. 
Where there is any doubt concerning a bone injury or an injury to 
the joint, the X-ray should be used, if it is available, to clear up the 
diagnosis. X-ray pictures should always be made of fractures in or 
around the joints. It should be always remembered, however, that 
X-ray examinations show merely shadows and that considerable skill 
and experience is necessary to interpret them correctly. 

First-aid treatment of simple fracture .—Before taking up the 
treatment of fractures it is necessary to describe emergency splints. 

When a fracture is suspected, lay the limb on a folded blanket, 
coat, pillow, or other fiat, soft object while splints are being pre¬ 
pared. 

Splints are used to prevent motion of the ends of the broken bone 
while the patient is being transported, and later on to hold the frag¬ 
ments in proper position and prevent motion while they are healing. 
Union can not take place if there is motion at the seat of a frac¬ 
ture. 

Emergency splints can always be devised from some material at 
hand. Light boards from broken boxes make excellent splints. Two 
or more pieces may be nailed together in order to get one strip of 
sufficient length. Heavy corrugated pasteboard is frequently used, 
also sections of tin gutters and properly shaped strips of tin. Other 
articles which suggest themselves are fence pickets, laths, umbrellas, 
canes, rifles, and even bundles of twigs. The material selected should 
be sufficiently rigid to support the weight of the limb and hold it 
immovable. 

The splints must be padded on the side which goes next to the 
flesh, as otherwise they are extremely painful and may seriously 
damage the skin. Cotton is the best material for padding, but 
other substances such as waste, pieces of old cloths or quilts, excel¬ 
sior, straw, grass, moss, etc., may be used. Special attention should 
be given to padding the end of the splint which will come against 
the body. Splints should be wide enough to give firm support; 
in the case of a forearm or leg, as wide as the part itself. Emergency 
splints can be applied over the clothing, which will help to cushion 
them and protect the part. 


248 


PREVENTION OE DISEASE AND CARE OF SICK. 


Applying splints .—In applying splints great care must be exer¬ 
cised in moving or handling the injured part. Both fragments of 
the broken bone must be supported when it is lifted or its position 
changed. When one splint is in place endeavor to overcome obvious 
deformity and get the part into a natural position by a very gentle 
manipulation. Then adjust the other splint and fasten them to 
the limb. 



1. First Aid Dressing Applied 2. First Aid Bandsge Around Hips 

Around Body for Broken R3fc for Broken Pelvis. 



Fig. 304.—Tomporary splints. (Courtesy American Red Cross.) 

Swelling very promptly follows most fractures and the limb is 
very painful and tender to touch. If the swelling is marked it is 
customary to remove the emergency splint as soon as the patient 
arrives home or at the hospital and to place the limb on a pillow 
and apply cold-water compresses or compresses of leadwater and 
opium for three days. Lead and opium wash is prepared by taking 














































Fig. 257. —Simple fracture. Fig. 260.—Plaster cast for fracture of the leg. (From Scudder’s Frac- 
(From Fowler's Surgery. tures. Courtesy W. B. Saimders Co.) 

Courtesy 7 W. B. Saunders 
Co. 1 ' 



Fig. 258.—X-ray picture of fracture of 
both bones of the forearm, showing 
sharpness of fragment. (From Da 
Costa’s Surgery. Courtesy W. B. 
Saunders Co.) 



Fig. 259.—Emergency splints for fracture of 
the forearm. 


49071 °— 23 


20 






















Fig. 261.—Dressing for fracture of the 
finger; splint fastened in place with 
strips of adhesive plaster. A bandage 
may be placed over the completed 
dressing. 



Fig. 262.—Fracture of the wrist, showing 
characteristic deformity. (From Da Cos¬ 
ta’s Surgery. Courtesy W. B. Saunders 
Co.) 



Fig. 263.— Dressing for fracture of the wrist (1). (From Scudder’s 
Fractures. Courtesy W. B. Saunders Co.) 



Fig. 264.— Dressing for fracture of the wrist (2). Note 
the position and the amount of padding, and that the 
upper splint is cut out for the ball of the thumb. 
(From Scudder’s Fractures. Courtesy W. B. Saunders 
Co.) 


















PREVENTION" OF DISEASE AND CARE OF SICK. 


249 


one-lialf of an ounce of tincture of opium and one-half of an ounce 
of liquor plumbi subacetatis. These two are mixed together and 
then this mixture is added to a pint of water, making the well- 
known leadwater and opium. This solution is much used in the 
treatment of bruises, sprained joints, and recent fractures where 
the skin is not broken. Gauze, towels, or similar material are rung 
out in the fluid and applied in the same manner as wet dressings. 
The remedy, is poisonous, however, and should be kept out of the 
reach of children and never taken internally. After the swelling has 
somewhat subsided the permanent splints are applied. It is advis¬ 
able to reduce the fracture and apply the permanent splints as soon 
as possible, because the longer this is postponed the more difficult it 
will become to get the bones into proper position. 

Permanent splints .—Permanent splints are made of wood, metal, 
or plaster of Paris. When plaster of Paris bandages are used the 
dressing is called a plaster cast. Permanent splints must be very 
thoroughly padded, especially the ends. When the splint is manu¬ 
factured at home the padding may be held in place by a piece of 
muslin which goes around the splint and is fastened by small tacks 
on the outside somewhat in the way the lid of a box is upholstered. 
A many-tailed bandage is useful in holding padding in place. 
Wooden splints should be as light as possible and cut and shaped 
to fit the part. Splints are worn from four to six weeks. When 
they are first applied the part should be carefully watched, as 
swelling may be developed and cause pressure of the splints against 
the flesh, followed by ulceration or even gangrene. The fingers or 
toes should be examined several times daily at first to determine 
that the circulation is not impeded. 

To apply this test press on the finger tip or toe firmly with the 
finger of the observer. Remove the pressure suddenly and a white 
spot will remain, but should quickly disappear if the circulation is 
all right. If the white spot fades away slowly, or if the fingers are 
blue, the splint should be loosened. Never apply a bandage around 
a limb under a splint. Splints will gradually work loose and get 
out of proper position. This should be borne in mind and the 
bandages reapplied or the splints readjusted whenever necessary. 

When the splints are taken off permanently the limb will be found 
to be stiff and painful when motion is attempted. It should be 
rubbed or massaged daily with grain alcohol or whisky. If a joint 
near the fracture is stiff, gentle passive motion should be begun, 
gradually increasing the amount and scope of the movements from 
day to day. Broken limbs in adults are often painful and more or 
less impaired for usefulness for six months and even longer. 


250 PREVENTION OF DISEASE AND CARE OF SICK. 

PLASTER OF PARIS CASTS. 

It is customary nowadays for surgeons to treat many fractures 
with plaster of Paris casts. These casts are made of coarse crinoline 
bandages impregnated with ordinary dry plaster of Paris. r lhe 
limb is protected by drawing a stocking over it, covering it with a 
woolen bandage, or a smooth layer of cotton batting. The plaster 
of Paris bandages are placed in a basin of cold water and allowed 
to remain until they are thorough^ wet, which is indicated by the 
cessation of bubbles of air arising from the roll. The bandage is 
then smoothly applied around the limb over the stocking or other 
material which has been placed around it to act as a cushion. 
During the process of application additional plaster of Paris, made 
by mixing it with water to the consistency of thin cream, is well 
rubbed into the bandage by the hands of the operator. The limb 
should be carefully supported while the cast is being applied by 
one or more assistants, and great care exercised that the broken 
bones are held and kept in the proper position until the plaster has 
thoroughly set and the cast is firm enough to permanently hold the 
bones in proper position. The thickness of the cast will depend 
upon the part to which it is applied. Light casts are sufficient for 
the hand or wrist, but much heavier ones must be used on the thigh 
or leg. The cast should be as light as possible, but must be suffi¬ 
ciently rigid to hold the fragments of the bone immovable in the 
correct relation to each other. 

Before starting to apply a cast the floor and bed should be well 
protected with newspapers and the operator and assistants by suit¬ 
able gowns or aprons, as considerable soiling of the surroundings 
with the plaster is unavoidable, especially in inexperienced hands. 
A solution of ordinary sugar in water will materially assist in getting 
the plaster off of the hands of the operator. 

Plaster casts are generally removed by splitting them up the front 
with a small saw or scissors especially made for that purpose. In 
the absence of regular instruments they may be divided by the cau¬ 
tious use of the point of a jackknife, care being taken not to cut the 
flesh underneath. The flannel bandage or cotton wadding which was 
first placed around the limb is a great protection to the part in cut¬ 
ting off the cast. 

Setting a bone .—As soon as the injury has been received and splints 
prepared efforts should be made to restore the bones to their natural 
position. This is called setting the fracture. It is easier to set a 
fracture immediately upon its receipt than after an interval of sev¬ 
eral days has elapsed, because the pain and swelling which gradually 
develop after the bone has been broken will materially interfere with 
its reduction. Inexperienced persons in endeavoring to set fractu res 


PREVENTION OF DISEASE AND CARE OF SICK. 251 

should use gentleness and not continue the effort too long. The re¬ 
duction may be assisted by pulling on the limb in such a way as to 
overcome the shortening. No layman should ever attempt to set a 
fracture unless it is certain that it will be absolutely impossible to 
obtain a physician for a considerable period. 

When the ends of the bones have been pulled apart cautious effort 
should be made to gently press them back into their proper place. 
Frequently the deformity will recur as soon as the pressure is 
removed. Attempts may be made to keep the bones in place by put¬ 
ting soft pads at suitable places between the splints. Efforts at 
reduction should not be carried too far, and the operator should be 
content with getting the limb in nearly as natural a position as 
possible. Fractures around the joint are apt to be followed by 
stiffness of the joint. If stiffness of the elbow is to be feared, the 
arm must be always placed in a position which leaves the arm and 
forearm at right angles, because a stiff joint in this position is very 
much more serviceable than one when the arm is fully extended. 
In the case of the knee, however, the leg should always be kept per¬ 
fectly straight, as a stiff knee joint in this position is very much more 
useful than one which is partly flexed. 

TREATMENT OF SIMPLE FRACTURES OF SPECIAL PARTS. 

Fractures of the fingers — Symptoms. —It is generally possible to 
obtain crepitus by gently rotating the ends of the fingers. 

First-aid treatment. —All that is necessary is to place the hand in 
a sling pending medical attention. 

After treatment. —Make a light wooden splint of cigar-box wood 
or similar material the width of the finger and long enough to ex¬ 
tend from the end of the finger well into the palm. Pad and apply 
(fig. 261). Keep the splint on for three weeks, and keep the hand 
during this period in a sling to avoid bumps and jars. 

Fracture of the hones of the hand — Symptoms .—Usually crepitus 
can be detected by. carefully manipulating the suspected bone. 

First-aid treatment. —Place, the hand in a sling. The other bones 
will act as a splint. 

After treatment. —Lay the hand on a splint which extends from 
the ends of the fingers half way up the wrist. Pad it well and place 
a large ball of padding where the palm will rest. Lay the hand and 
forearm on the splint and put it in as good a position as possible. 
Fasten the hand to the splints with a roller bandage or a many¬ 
tailed bandage. Then place the hand in a broad sling. Keep the 
splint in position for three weeks, beginning passive motion of the 
fingers at the end of the second week. 


252 


PREVENTION OF DISEASE AND CARE OF SICK. 


Fracture of the wrist .—This is very often produced by a fall on 
a slippery pavement, the patient striking the ground with the palm 
of the hand in his effort to save himself. 

Symptoms .—Marked deformity (fig. 262) and numbness of the 

fingers. 

First-aid treatment .—No splint will be required in most cases, it 
being sufficient to place the arm and hand in a broad sling. If the 
patient is to be transported for some distance, it will be well to 
make a trough about 6 inches long of heavy cardboard, tin, or many 
thicknesses of newspaper, line it with some soft material, and place 
the wrist in this trough, binding it lightly with several handkerchiefs 
or strips of muslin. The trough, of course, is placed in the sling, 
which is wide enough to support the hand and forearm. 

After treatment .—Attempt to reduce deformity by cautious manip¬ 
ulation. Efforts at overcoming deformity can sometimes be assisted 
by pushing the hand backward into the position it was when the 
injury was received and then pushing the base of the hand forward 
so that the lower fragment of the bone comes into the proper posi¬ 
tion when the hand is bent forward while maintaining traction in 
the axis of the limb. Apply cold-water dressings for several days, 
keeping the hand and arm in a sling, if swelling is very marked. 
After swelling has subsided, put the arm up in a permanent dress¬ 
ing. Make two splints of light wood about 3J inches wide. One 
of these goes on the under side of the forearm when the palm is 
turned upward, and should be long enough to run from near the 
elbow to the beginning of the fingers. This splint is well padded 
and the forearm laid on it, palm upward, with a pad under the wrist 
(fig. 263). The upper splint should extend from 2 inches below the 
bend of the elbow- to about the end of the palm. This splint should 
be cut out on the thumb side to make a place for the ball of the thumb 
(fig. 264). Put plenty of padding at the lower end of the splint 
(fig. 264). Fasten the splints in place with adhesive plaster or strips 

of bandage. Do not apply them too tightly. Place the forearm 
in a wide sling with the palm toward the body and the thumb up, 

but the fingers hanging loose outside of the sling (fig. 267). At the 
end of a week, take off the upper splint and use the lower one only, 
holding it in place with a bandage (fig. 265). Apply passive motion 
to the fingers. Remove the remaining splint at the end of three 
weeks and support the forearm in a sling, using passive motion to 
fingers and wrist. At the end of the fourth w y eek allow patient to 
begin to use hand. 

FRACTURES OF FOREARM. 

The arm extends from the shoulder to the elbow; the forearm 
from the elbow to the wrist. There are two bones in the forearm. 
Either one of these bones may be broken or both. When only one 



Fig. 265.—Lower splint to be used alone at the 
end of first week in fracture of the wrist. 
(From Scudder’s Fractures. Courtesy W. B. 
Saunders Co.) 



Fig. 266.—Dressing foi fracture of both bones of the fore¬ 
arm. (From Scudtler’s Fractures. Courtesy W. B. 
Saunders Co.) 



Fig. 267.—Sling for fracture of both bones of 
the forearm. (From Scudder’s Fractures. 
Courtesy W. B. Saunders Co.) 



Fig. 268.—Jones’s position for dressing all 
fractures near the elbow joint except 
fracture of the tip of the elbow. 































Fig. 269.—Wedge-shaped pad to go in the armpit for fracture 

of the arm. 



Fig. 270.—Showing pad and splints in position 
for fracture of the arm. The splint in the 
rear does not show. 


Fig. 271.—Completed dressing for fracture 
of the arm. Note that a narrow sling is 
used to support the hand. 


y 












PREVENTION - OF DISEASE AND CARE OF SICK. 


253 


bone is broken the other acts as a splint and the symptoms of frac¬ 
ture may not be clear. In cranking an automobile, if the motor back¬ 
fires the crank will be violently whirled around in the reverse direc- 
tion and frequently causes fracture of the forearm of the operator. 

Symptoms of fracture of both bones of the forearm. —Pain, in¬ 
ability to turn palm upward and downward, possibly grating, false 
motion. 

First-aid treatment .—Bend the forearm to a right angle with the 
arm. Apply two padded emergency splints extending from the 
elbow to the knuckle. Lay the forearm and the hand on the lower 
splint, gently straighten the part as well as possible, and place the 
other splint on the back of the hand and arm. Fasten in place the 
bandage or strips of muslin and support the arm and hand in a 
broad sling. 

After treatment .—When the patient is in bed remove emergency 
splints, place arm and forearm on a pillow, try to restore bones to 
their natural position, and apply cold compresses for several days. 
When swelling is reduced make two splints of light wood about 3^ 
inches wide and long enough to run from the elbow to the knuckle. 
Pad the splints well and apply to the forearm as directed above. 
Fasten the splints with strips of adhesive plaster, straps, or a band¬ 
age (fig. 266). Lay arm across the body with the thumb up in a broad 
sling (fig. 267). Keep the splints on for four weeks. Passive motion 
should be begun after three weeks, removing the splints daily for 
that purpose. 

FRACTURES AROUND THE ELBOW JOINT. 

Some surgeons treat all fractures around the elbow joint, either 
above or below, except fracture of the tip of the elbow (the ole¬ 
cranon) by Jones’s position. The arm is bent at the elbow, placed 
against the side and the hand of the affected side held at the base of 
the neck by a bandage fastened around the wrist and suspended from 
the neck (fig. 268). This mode of dressing injuries around the elbow 
joint is extremely simple and recommends itself to the laity on that 
account. It is necessary, however, to observe certain things. After 
the hand has been placed in the proper position and fastened there 
with the dressings, the operator must be certain that he can feel the 
pulse at the wrist. It is also necessary to examine the arm daily for 
the first 10 days. If the swelling is growing worse the hand should be 
lowered a little. If the pulse can not be felt at the wrist it is neces¬ 
sary to lower the hand until such a point that the pulse returns. The 
arm is held in this position for from three to six weeks. At the end 
of the first two weeks the wrist is lowered an inch or so. At the end 
of three weeks the dressing should be taken off daily and a little 
passive motion applied very cautiously. 


254 


PREVENTION OF DISEASE AND CARE OF SICK. 


Considerable padding must be applied around the neck in order 
to prevent the pain which the weight of the arm will cause to that 
part of the body unless this precaution is carried out. A leather 
band around the wrist or a glove from w T hich the fingers have been 
removed may also be utilized as a means of holding the hand in the 
desired position, the glove or leather band being fastened to the 
neck bandage by suitable strips. 


FRACTURE OF THE ARM 


Fractures of the arm are common, but it is sometimes difficult to 
get union. 

Symptoms. —Pain, shortening, inability to move the arm, and 
sometimes crepitus and false motion may be detected. The appear- 




Fig. 272.—Method of cutting card¬ 
board for shoulder cap. 


Fig. 273.—Shoulder cap made. 


ance of black and blue spots on the arm after an injury in places 
which have not been bruised themselves should suggest the like¬ 
lihood of a fracture. 

« 

First-aid treatment .—Place a broad wedge-shaped pad between 
the chest and the arm long enough to extend from the arm pit nearly 
to the elbow 7 . The edge of the wedge goes into the armpit (fig. 269). 
This pad may be constructed of tow 7 els or even folded newspapers 
wrapped in some soft material. It is held in place by a band or 
strips going over the opposite shoulder. The pad gives a firm, 
straight surface to support the arm on the inside. Apply three short 
narrow padded splints to arm running from the shoulder to the 
elbow, one on the outside, one behind, and one in front (fig. 270). 














PREVENTION OP DISEASE AND CARE OF SICK. 


255 


Hold the splints in place with a many-tailed bandage, or three strips 
of muslin. Fasten the arm to the chest with a bandage going around 
the rest of the body or with strips of adhesive plaster or a towel 
pinned in place. Place the forearm in a sling 

and use a narrow sling supporting the wrist 
only (fig. 271). 

After treatment .—For after treatment use 
the same dressings and splints more carefully 
applied, that is wedge-shaped pad between the 
arm and chest, three splints around the arm. 

Bring the forearm up so that it makes a right 
angle with the arm. Fasten the arm to the 
side by bandages and support forearm in a 
narrow sling at wrist. Allow splints to remain 
on for five weeks, frequently adjusting them 
and the bandages. A narrow sling is advisable 
here because it allows the weight of the fore¬ 
arm to help in overcoming shortening. 

In fractures near the shoulder joint, a shoulder cap should be ap¬ 
plied in addition to the other dressings. The cap can be constructed 
of binder’s board which has been softened in hot water, or heavy 
pasteboard (figs. 272, 273, 274). The binder’s board should be long 
enough to run about halfway down the arm and wide enough when 
shaped to the arm to about half encircle the part. 

FRACTURE OF THE SKULL. 

Fracture of the skull may occur at the top or vault of the skull, 
or the lower part, when the}^ are known as fractures of the base of 
the skull. 

Fractures of the skull are serious injuries and may be due to blows, 
falls, or other accidents. 

Fracture of the upper part of the skull can often be felt by run¬ 
ning the finger over the scalp, the depression in the bone being easily 
detected. The gravity of fractures in this location depends largely 
on the damage done to the brain and blood vessels. If large arteries 
have been ruptured inside the skull the blood pours out and com¬ 
presses the brain giving rise to symptoms of brain compression 
(p. 289). 

Fractures of the base of the skull .—Fractures of the base of the 
skull are generally compound the wound not being visible, but in the 
nose, pharynx or ears. They are of course very dangerous injuries. 

Symptoms .—There may be partial or complete loss of conscious¬ 
ness, bleeding, or the escape of blood-stained fluid from the nose or 
ears and paralysis of the face. Later the symptoms of compression 
may be developed such as paralysis, slow stertorous breathing, un¬ 
equal pupils, etc. (p. 289). 



Fig. 274.—Shoulder cap 
applied. 





256 


PREVENTION OF DISEASE AND CARE OF SICK. 


First-aid treatment .—Send for a doctor at once. Raise the head 
on a pillow or folded coat. Treat shock by applying hot-water bot¬ 
tles, jugs filled with hot water, or hot bricks around the feet and 
bod} 7 . Be careful not to burn an unconscious patient. Do not give 
whisky or other stimulants. 

A fter treatment .—Place the patient in bed with the head elevated. 
Apply an ice bag to the head. An ice bag may be improvised by put¬ 
ting pieces of cracked ice in a piece of oil cloth, part of a rubber 
coat or similar waterproof material. Apply heat to the extremities 
as directed above. Do not give stimulants. 

If there is a wound in the scalp, dress the wound with sterilized 
gauze or other material and apply an ice bag. If there is no wound 

of the scalp cold may be applied to the 
head by means of towels rung out in cold 
water and frequently changed. If the 
patient can not pass his urine naturally, 
it may be necessary to boil a soft-rubber 
catheter and draw the water by insert¬ 
ing it into the urinary passage. Before 
doing this the operator should carefully 
and thoroughly clean his hands. 

FRACTURE OF THE NOSE. 

Symptoms. —Pain, swelling, hemor¬ 
rhage from the nose and deformity. 

First-aid treatment .—Nothing special 
is required unless it becomes necessary 
to check hemorrhage. Attempts may be 
made to mold the nose into proper shape 
or position by the fingers. Fractures of 
the nose should always be treated by a physician when one is 
available. 




fracture of the lower 
jaw out of a piece of 
moistened cardboard. 


FRACTURE OF THE LOWER JAW. 


Fracture of the lower jaw is often due to a blow from the'fist or 
a kick in the face when the individual is lying on the ground. 

Symptoms. —Pain, the teeth may be out of Tine and it may be pos¬ 
sible to detect unnatural mobility, or crepitus, when the jaw is firmly 
grasped on each side and gentle motion in various directions at¬ 
tempted. 

First-aid treatment .—Apply a four-tailed jaw bandage (fig. 217). 
If there is much bleeding in the mouth it may be washed out with 
water as hot as it can be borne, or a piece of ice may be held in the 
mouth. 











PREVENTION OF DISEASE AND CARE OF SICK, 257 

After treatment .—Do not remove loose teeth. Put the jaw into 
its natural position, using the fingers inside the mouth for this pur¬ 
pose, if necessary, then apply a small compress of gauze to the chin 
and hold jaw in place with a four-tailed jaw bandage (fig. 218). In 
cases of compound fracture a good deal of discharge may occur and 
the mouth become foul. When this happens it will be necessary to 
use mouth washes. Sometimes the broken fragments may be held in 
place by wiring the teeth with fine wire. The bandage should be 
worn for five weeks and only liquid food allowed. This may be in¬ 
troduced through a tube inserted between the cheek and teeth. The 
mouth should be frequently washed out with a solution of a heaping 
tablespoonful of boric acid powder to a pint of water. 

FRACTURE OF THE COLLAR BONE. 

Fracture of the collar bone is frequently due to a fall in which 
the person strikes with the weight on the hand. 

Symptoms .—The patient generally supports the injured arm with 
the other hand. It is easy to detect a fracture of the collar bone, 
because the bone is placed directly under the skin and the deformity 
may be seen or felt. Always compare with the other side. Stand 
behind the patient with his clothing removed and grasp the collar 
bone on each side between the fingers. Make gentle motion. It will 
be found that the bone on the injured side can be moved and on the 
other side it is rigid. 

First-aid treatment .—Make a pad of towels, newspaper, or other 
flexible material and place in between the arm and the side in the 
armpit. Keep the pad in position by straps going over the opposite 
shoulder. Bind the arm to the side by bandages, a towel, or strips of 
muslin, and then make a sling which specially supports the point of 
the elbow so as to raise the elbow up. 

After treatment .—The best form of treatment, if it is necessary for 
an inexperienced person to assume charge of the case, is to put the 
patient in bed with a small pillow or a large pad between the shoul¬ 
ders and place a bag of sand over the point of the fracture. The 
forearm should be placed on the front of the chest and the arm held 
to the side by bandages, running around it and the body, or by pin¬ 
ning a towel around it and the body. Keep in bed for three weeks. 

FRACTURE OF THE RIBS. 

These Injuries are often due to kicks in the side from heavy boots 
with the person lying on the ground. They may, however, be due 
to direct violence of all kinds. 


258 


PREVENTION OF DISEASE AND CARE OF SICK. 


Symptoms. —Pain which is likely to be sharp and stabbing, when 
the patient takes a deep breath or when he coughs. It may be pos¬ 
sible to detect unnatural motion in a broken rib by carefully running 
along its course from the backbone to the breastbone and making 
pressure. Crepitus and grating can sometimes be felt when the hand 
is held over the seat of injury and patient coughs, or when one of the 
broken pieces is pressed inward. 

First-aid treatment. —Wrap a strip of muslin or a towel around the 
chest tightly and pin it. Support with straps running over the shoul¬ 
ders (fig. 276). 

After treatment. —If the chest is very hairy, shave it, then place 
the patient on a stool with the clothing removed to the hips. Strap 
the affected side firmly with strips of adhesive plaster running from 

well over the backbone behind, around 
the affected side and across the breast¬ 
bone in front. Cover one side of the chest 
completely with these strips, each over¬ 
lapping the other for about half their 
width (fig. 277). The strips should be 2J 
inches wide. Have the patient empty the 
chest of air at the moment each strip is 
being applied. In the absence of ad¬ 
hesive plaster pin a towel tightly around 
the chest, supporting it with straps over 
the shoulders, as described in the first- 
aid treatment. 


BROKEN NECK OR BACK. 


Contrary to common belief, it is pos¬ 
sible for a person with a broken neck 
or back to recover and live for many 
years. These injuries, however, generally 
severely damage the spinal cord, which is inclosed in the backbone, 
and more or less permanent paralysis results. 

Symptoms. —Inability to move the legs. Loss of feeling in the 
members which are affected. If a severely injured person who is 
conscious can not move his legs, always suspect fracture of the back. 

First-aid treatment. —The first-aid treatment of a broken back is 
very important, for if the injury is high up and the patient is roughly 
moved, the sharp edges of the broken bones may crush or compress 
the spinal cord to such an extent that instant death results. There¬ 
fore, if circumstances permit, do not move the patient at all pending 
the arrival of a doctor. If it is impossible to secure a physician, the 
patient should be lifted or moved only on a blanket or sheet sup¬ 
ported at the four corners and the sides. 



for fractured ribs. 


) 









Fig. 277.—Strapping the side for fracture 
of the ribs. 



Fig. 278.—Method of changing a sheet, step one. One side of the clean 
sheet is rolled up preparatory to putting it on the bed. 



Fig. 279.—Method of changing sheet, step two. The patient is shown 
lying on his right side on a blanket for the sake of clearness. The 
blanket is rolled up against him and the new sheet is placed so that 
the rolled-up edge is against the rolled-up blanket. 














































Fig. 280.—Method of changing a sheet, step three. The patient is 
turned on his left side, going over the two rolls in the process. Ho 
is now resting on the clean sheet and the blanket may be withdrawn 
and the sheet spread out over the rest of the bed. 



Fig. 281.—Method of measuring length of the limb in fracture of the 

thigh. 



Fig. 2S2.—Emergency dressing for fracture of the thigh. 

















PREVENTION OF DISEASE AND CARE OF SICK. 


259 


METHOD OF CHANGING OR PLACING A SHEET UNDER A VERY 

SICK OR INJURED PERSON. 

It is important to know how to change a sheet under a very sick or 
injured man with the least amount of disturbance to the patient. 

Remove the pillow. Turn the patient gently on his right side. 
The old sheet is now rolled up into as small a bulk as possible, begin¬ 
ning at the edge toward the operator and the roll continued until it 
is snugly up against the back of the patient (fig. 278). The new sheet 
is spread on the floor and the edge toward the patient is rolled up 
in a similar fashion until a little less than half the width of the sheet 
has been used. The new sheet is then placed on the bed with the 
rolled side against the roll of the old sheet (fig. 279). The unrolled 
part of the new sheet is straightened out and tucked in place at the 
head and foot of the bed. The patient is now gently turned on his 
left side, the body rolling over the folded parts of both sheets. The 
rolled up parts of the sheets will now be again toward the back of the 
patient, but he will be resting on his left side on the clean sheet 
(fig. 280). The old sheet is then taken away and the rolled up part 
of the new sheet is undone and the sheet smoothed out and tucked 
into place. The patient now turns onto his back and the change is 
completed. 

The same method is used in placing a sheet or blanket under a man 
with a broken back. He is then lifted by raising the corners and 
sides of the sheet onto a stretcher or other appliance for transpor¬ 
tation. 

The litter used for carrying such a case should be made out of 
boards or other rigid material in order to insure against any likeli¬ 
hood of permitting the backbone to be bent or disturbed while the 
patient is being carried. It is necessary, of course, to pad such a 
stretcher liberally with a number of blankets, a mattress, or similar 
material. 

After treatment .—Patient should be kept in bed and made as com¬ 
fortable as possible. If incontinence of urine and feces results, as 
is sometimes the case, a rubber sheet should be placed over the mat¬ 
tress and especial care exercised to prevent the formation of bed 
sores. The back and buttocks should be frequently washed with soap 
and water, the skin dried with a soft towel, and a mixture of equal 
parts of alcohol and water or whisky or brandy dabbed on with a 
pledget of cotton. A good dusting powder should be used, such as 
talcum, or if this is unobtainable ordinary cornstarch makes a good 
substitute. 

/ 

FRACTURES OF THE LOWER EXTREMITIES. 

The thigh extends from the knee to the hip and the leg from the 

knee to the ankle. 

49671 23-21 



260 


PREVENTION OF DISEASE AND CARE OF SICK. 


FRACTURE OF THE THIGH BONE. 

Symptoms .—If the ends of the bone are driven together, as they 
sometimes are, especially near the hip joint, the symptoms may be 
very slight, and it will be difficult for the inexperienced to tell 
whether there is a fracture or not. All fractures in the middle part 
of the bone will give the following symptoms: 

Pain, inability to stand on the injured leg, shortening, and it will 
be noted that the toe on the affected side falls out. When it is placed 
in its natural position it again drops in a helpless manner. It may 
be possible to detect crepitus. Shortening is determined by care¬ 
fully measuring the leg on each side with a tape measure or a string. 
The patient should be lying with his legs straight with the body. 
Feel around the front part of the haunch bones or pelvis until two 
bony prominences are detected in a similar location on each side 
(fig. 281). Mark these spots with a little ink. In the same way 
mark the two most prominent bony prominences on the inner side of 
the ankle, which can easily be felt through the skin. Now measure 
the distances between these two points on each side. In fracture of 
the thigh there may be anywhere from an inch to 3 inches of 
shortening. 

First-aid treatment .—Apply a long splint on the outside of the 
affected leg extending from the heel to the armpit. Pad it on the 
side toward the body. Apply another splint on the inside of the 
leg, extending from the crotch to the heel. Fasten these splints by 
at least three strips of muslin or similar material around the body 
and five around the leg and thigh (fig. 282). These strips should be 
placed under the patient before the splints are applied. In lifting 
the thigh for this purpose have one assistant carefully support both 
ends of the broken bone and another the foot when the broken 
extremity is lifted from the ground. The leg should be carefully 
lifted by one person when the patient is being placed on a stretcher. 
Treat shock if it is present. 

After treatment .—Place the patient on a hard mattress and put 
two boards under the bed spring with their ends resting on the sides 
of the bed to keep it from sagging in the middle. Make an exten¬ 
sion apparatus made out of a long strip of adhesive plaster. This 
strip should be about 3 inches wide and long enough to extend from 
the break down one side of the leg 6 inches beyond the heel, and up 
again on the other side to the point of injury. A piece of wood about 
3J inches long and 3 inches wide, with a hole in the middle, is fas¬ 
tened exactly in the middle of this strip of adhesive plaster on the 
sticky side. It may be held in place by a short strip of adhesive 
which goes over it. This strip should be about 18 inches long. In this 
manner a stirrup or spreader is constructed in the center of the 
adhesive, which prevents it from touching the heel when the strip is 




*ig. 286.—Long splint for fracture of the thigh with cross 
strip near bottom to keep it from turning. 



Fig. 287.—Method of preventing eversion of the toe in 
fracture of the thigh by fastening a strip of adhesive 
plaster to the back and inner side of the leg and carrying 
it over the long side splint. (From Scudder’s Frao- 
tures. Courtesy W. B. Saunders Co.) 


















































Fig. 288.—Framework constructed of hoops to support 
bed clothing for a patient with a broken leg or thigh. 




Fig. 290.—Showing construction of improvised bedpan, 


dsM-.. 


















PREVENTION" OF DISEASE AND CARE OF SICK. 261 

pulled upon (fig. 283). The adhesive-plaster strip is split in three 
pieces to within a foot of the spreader and is applied to both sides 
of the thigh and leg from the injury down to the ankle (fig. 284). 
The apparatus may be reinforced by several circular strips of plaster, 
but these should not completely surround the limb for fear of shut¬ 
ting off the circulation (fig. 285). A bandage is applied over the plas¬ 
ter. The adhesive plaster is allowed to set for about an hour. A 


r — --- 


mi 

A 

~~1 


c 

a 


-- D 


Fig. 283.—Method of constructing apparatus for fracture of the thigh. (A shows the 
long strip of adhesive plaster; B shows the short strip ; C is the block of wood 4 by 3 
by i inches with a hole in the centei ; D shows the block placed between the two strips 
of plaster, all ready for application to the leg or thigh.) 

rope is then passed through the block and knotted at the end nearest 
the foot. This rope is laid over a pulley fastened to a board attached 
to the foot of the bed. In the absence of a pulley, the rope may be 
run over a round piece of wood. Weights such as bricks or bags of 
sand are fastened to the loose end of the rope so that the pull comes 
on the leg. A bucket containing sand or pebbles makes a good 
weight. 



Fig. 285.—Extension apparatus showing circular strips for reinforcement; also weight 
applied. The circular strips should not completely surround the limb. 

To prevent the patient from sliding down on the mattress the foot 
of the bed is elevated on blocks or boxes from 6 to 10 inches high. 
Start with about an 8-pound weight and gradually add additional 
weight until the injured leg is the same length as the other. Now 
apply a long splint, running from the armpit to below the heel on the 
outside. This splint should have a light piece of board nailed to the 
lower end on the under edge to prevent it from turning inward or 
outward (fig. 286). Another splint is placed on the inside of the leg, 
extending from the crotch to the heel. Both splints should be well 




































202 


PREVENTION OF DISEASE AND CARE OF SICK. 


padded. Long bags of sand about 4 inches in diameter will assist in 
keeping these splints in place. Care should be taken to avoid the 
dropping out of the toe, and this should be overcome by suitable pads 
placed between the foot and the splint. A very good way to avoid 
the toe dropping out of position, as suggested by Dr. Scudder, is to 
fasten a strip of adhesive on the inner side of the leg, pass it under 
the leg, then run it over the splint and attach to the outside of the 
splint (fig. 287). In fractures of the thigh and leg it will be necessary 
to improvise some sort of device to prevent the bed covering from 
weighing down the foot and interfering with the action of the appa¬ 
ratus. This may be constructed out of barrel hoops or light strips of 
wood (fig. 288). If the bones appear to bulge forward in the middle 
of the thigh, a short splint, well padded, can be fastened to the front 
of the thigh over the bulging. The dressings and the foot should be 
examined twice a day in order to see that everything is in proper 
position. Liberal padding should be placed under the heel and also 
under the knee joint. The patient should remain in bed with the 
splints applied for from 8 to 10 weeks. The amount of weight may 
be lessened at the end of the sixth week and the splints occasionally 
removed and passive motion applied to the knee joint. The pulley 
should be so adjusted that the cord supporting the weight is in a line 
with the limb. 

If adhesive plaster can not be obtained, an extension apparatus of 
some value may be improvised out of a shoe. Secure, if possible, fy 
shoe one or two sizes larger than ordinarily worn. Cut two slits 
about an inch long on each side of the shoe just above the sole under 
the instep. Pass a strap through these holes. Put two or three pairs 
of heavy woolen socks on the foot and then apply the shoe. Lace it 
up snugly, and extension may be produced by fastening a rope to 
the loop of the strap under the sole of the foot and applying weights 
to the other end of the line running it over a pulley if possible, as 
directed for the ordinary apparatus. 

It is advisable to give a patient who has received a fracture of 
the thigh or leg 10 grain doses of sodium bromide in water after 
meals and at bedtime for the first four or five days. The bromide 
helps to allay pain, overcomes muscular spasm, and produces sleep. 
Confinement in bed is very irksome to these patients at first, and the 
medicine helps to tide them over until they have become accustomed 
to it. 

It will be necessary for the patient to use a bed pan, and if one is 
not at hand a substitute of some sort must be constructed. Recep¬ 
tacles for this purpose may be improvised in various ways. One 
method is to take a shallow pan and to construct a low framework of 
wood in which the pan is inserted so that there is a smooth wooden 
rim about 2| inches wide around the pan and flush with its top on 



Fig. 292.—Double incline plane for fracture of the upper part of the thigh bone. (From Fow¬ 
ler’s Surgery. Courtesy W. B. Saunders Co.) 





^\\\V\\iV^\^\\\\\\W\\\iUl ‘jDlVk 1QR \ VTOuflu^ 


iH'wmiiuiwimuuii 


Fig. 293.—Hodgen’s splint for fracture of thigh (1). (From Stimson’s Fractures and Bisloca- 

tions. Courtesy of Lea & Fabigler.) 

























.JIG. 294.—Thomas wire splint. (From Blake & Bulkley. Courtesy 
Surgery, Gynecology and Obstetrics.) 



t rr 


































































PREVENTION OF DISEASE AND CARE OF SICK. 


263 


which the patient rests. The framework keeps the pan from up¬ 
setting. Pending the securing of some convenience of this sort the 
bowel discharges may be received on pads of oakum, old newspapers, 
or similar material. 

There are many ingenious and complicated appliances for treating 
fractures of the thigh, but they are scarcely within the scope of a 
manual of this sort. 

The double incline plane (figs. 291, 292) is very often used for frac¬ 
tures of the thigh near the hip joint. A good idea of how this 
apparatus is constructed can be obtained from examining the illus¬ 
trations. The plane itself is made of boards, and it should be thor¬ 
oughly padded. The extension apparatus has to stop at the knee, 



Fig. 291.—Shows a double-incline plane with the weight and pulley—1 is the double- 
inclined place, 2 and 3 are circular pieces of adhesive plaster to prevent 4, the longi¬ 
tudinal strip on each side of the thigh, from slipping; 5 and 6 are the pulley and 
weight. 

and on account of its shortness it is sometimes difficult to keep in 
place. 

All fractures of the thigh are more conveniently treated if the limb 
can be suspended in some manner. This makes it very much easier 
to place a bed pan under a patient and also permits of considerably 
more freedom of the body in the bed. A very popular splint which 
fulfills these requirements is a sort of suspension cradle made of two 
iron rods running along the sides of the limb and held together by 
cross bars at their upper and lower ends. Strips of bandage or light 
canvas are fastened across the bars and the limb rests in the ham¬ 
mock thus formed. The whole apparatus is then supported by cords 
passing over pulleys fastened to a beam above the bed (figs. 293, 295). 
Some form of extension is, of course, used with these splints. 




















264 - 


prevention OF DISEASE AND CARE OF SICK. 


When a patient is to be transported for a considerable distance % 
Thomas wire splint (fig. 294) has proven very satisfactory, espe¬ 
cially in injuries received on the battlefield. The extension in 
figure 296 is made by means of canton-flannel strips attached to the 
leg by glue, as described in the note below, counter-extension by a 
ring around the upper part of the leg. Sufficient traction should be 
placed upon the flannel, strips to bring the ends of the broken bone 
int(> proper position, and the strips should then be wound around 
the bottom of the splint, after pushing the ring firmly against the 
hip to insure the broken bones being kept in this position. Care 
should be taken to put plenty of cotton around the ring at the upper 
part of the splint, and the position of this ring should be slightly 
changed each day and the skin dusted with talcum powder to keep 
it from becoming chafed. 

Note.— In case adhesive plaster can not be obtained a very satisfac¬ 
tory means of extension can be devised by gluing suitable strips of 
canton flannel or similar material to the sides of the leg, the appa¬ 
ratus in all other respects resembling that constructed out of adhesive 
plaster (fig. 284). The glue for this purpose is preferably made 
according to the following formula: 

Common glue, 50 parts; water, 50 parts; glycerin, 2 parts; thymol, 
1 part; calcium chlorid, 1 part. 

This is painted on the skin warm, in a direction opposite to that 
in which traction is to be made to avoid the discomfort of pulling 
the hairs. Such an extension apparatus will hold for 10 days or 
longer, and if it becomes loose a new one can easily be reapplied. In 
cases of emergency it would probably be possible to use a simple mix¬ 
ture of equal parts of glue and water, adding the proper amount of 
glycerin, however, if it is obtainable. 

FRACTURE OF THE KNEE CAP. 

Symptoms .—The patient can not stand and is unable to raise the 
limb from the ground. Very often separation of the two pieces of 
bone may be felt by the fingers if the case is examined before swell¬ 
ing has set in (fig. 297). 

Treatment .—Make a splint about 3 feet long and 4 inches wide. 
Pad it well and place it under the thigh and leg. Fasten it in place 
with a number of handkerchiefs, strips of muslin or a bandage. 

After treatment .—The aim of the treatment is to force the two 
ends of the broken bone together and keep them in place. This is 
difficult. A strip of adhesive may be applied just above the upper 
fragment and then brought downward and attached to the splint so 
as to pull the fragment down. A similar strip is passed across the 
lower fragment and attached farther up to the splint to pull the lower 


Fig. 296.—Extension by means of Thomas splint. (From New York Medical 

Journal.) 








Fig 297.—Methods of applying extension in fracture of the 
leg. (From Blake & Bulkley. Courtesy Surgery, Gyne¬ 
cology and Obstetrics.) 















































Fig. 298.—Fracture of the kneecap. (From Fowler’s Surgery. Courtesy W. B. Saunders Co.) 



Fig. 299.—Fracture of the kneecap dressed with adhesive plaster. 
(From Fowler’s Surgery. Courtesy W. B. Saunders Co.) 




























PREVENTION OF DISEASE AND CARE OF SICK. 265 

fragment up (fig. 299). Handkerchiefs may be applied in the same 
manner (fig. 298). The splint should be elevated at its lower end to 
relax the muscles of the leg. The restraining bands around the knee 
cap should be tightened every few days in order to take up slack. 
The splint should be worn for about six weeks, the patient, of course, 
remaining in bed. It may be replaced by a short splint and a firm 
bandage, which should be worn for at least a month. Stiff joints 
are very apt to follow fracture of the knee cap. 

FRACTURES OF THE BONES OF THE LEG. 

The leg extends from the knee to the ankle joint and contains two 
bones. The larger bone of the leg is called the tibia. The other 
bone is long and slender and placed to the outer side, called the 
fibula. 

Either or both of the bones of the leg may be broken. If only one 
bone is fractured the other acts as a splint and it may be difficult to 
make a correct diagnosis of the injury. 

FRACTURE OF BOTH BONES OF THE LEG. 

Symptoms. —The patient is unable to stand. There is generally 
deformity and false motion. Crepitus may be detected. 

First aid treatment .—Apply two well-padded splints to the sides of 
the legs extending from well above the knee to below the heel. 
Fasten in place with five strips of bandage or muslin (fig. 300). If 
a pillow is available, lay the leg on the pillow. Bring the sides of 
the pillow up around the leg and tie them in place with strips of 
muslin or bandage. A folded blanket may be used in place of a 
pillow. Two side splints may be now placed, without padding, on 
the outside of the pillow or blanket (fig. 302). If no other appliances 
are available, the injured leg may be fastened to the other leg with 
strips of bandages or handkerchiefs, the sound limb acting as a 
splint. 

After treatment .—Place the patient in bed and lay the leg upon a 
pillow covered with a pillowcase, the end of the case being at the 
foot. Bring the sides of the pillow up around the leg and hold in 
place with four straps or strips of muslin. Place pieces of towel 
over the shin bone where the straps cross the leg to prevent pressure. 
Slip three thin boards between the pillows and the straps, one un¬ 
derneath, the other two at the sides (fig. 302). Pin the ends of the 
pillowcase around the foot. Leave the leg in this dressing for 10 
days, tightening the bands and rearranging the pillow as necessary 
so as to insure that the ball of the big toe, the inside of the ankle 
joint, and the inside of the knee are in the same vertical plane. Then 
apply a plaster of Paris cast. The leg should be covered from the 


266 


PREVENTION OF DISEASE AND CARE OF SICK. 


toes to above the knee with two long cotton stockings, an even layer 
of cotton batting, or a smoothly applied flannel bandage. The cast 
should extend from above the knee down to the toes. (See directions 
for applying plaster of Paris casts on p. 250.) Great care must be 
exercised in having the assistants support the broken bones in the 
proper position while the cast is being put on and until it has hard¬ 
ened. The foot must be at a right angle w r ith the limb; and the ball 
of the big toe, the middle of the ankle joint, and the inside of the 
knee must be on the same vertical plane. From four to six 3-inch 
bandages will be required to make a dressing of sufficient strength 
for the proper results. The cast should be applied firmly, but not so 
tightly as to shut off the circulation. This can be tested by examin¬ 
ing the condition of the toes as described on page 249. If they be¬ 
come blue or dark, the cast must be cut off. This dressing is worn 
for four weeks, when the patient may be allowed up, using crutches 
for two weeks and a cane for two weeks longer. 

If plaster of Paris bandages are not available, at the end of 10 
days put the foot in a fracture box, which is best understood by con¬ 
sulting figure 303. When 
the foot is in the fracture 
box be careful to get suffi¬ 
cient padding under the 
heel and under the toes to 
keep the foot vertical with 
the leg and to prevent 
excoriation of the flesh. 
The fracture box should be suspended about 2 inches above the box 
by ropes running from both ends of the box to a bar suitably sup¬ 
ported above the bed. Keep the foot in the box for four weeks, then 
let the patient up, using crutches for two weeks and a cane for two 
weeks longer. 

POTT’S FRACTURE. 

A fracture of the outer bone of the leg—that is, the fibula—a few 
inches above the ankle is known as a Pott’s fracture. It is a very 
common injury. 

Symptoms .—The foot points outward and there is unnatural mo¬ 
tion at the ankle joint. 

First-aid treatment .—The same as described above for fracture of 
both bones of the leg. 

After treatment .—Put the patient in bed and lay the leg on a 

pillow. Overcome the deformity as well as possible. The foot must 
be turned in and held in that position. It may be necessary to apply 

cold compresses for three or four days to reduce swelling. Then ap¬ 
ply a straight splint, specially padded, to the inner side of the leg, 




Fig. 300.—Emergency dressing for fracture of the leg. Two side splints 
padded with underclothing and fastened with neckties, handkerchief, 
and stockings. 



Fig. 301.—Fractured leg dressed with a pillow and side splints, step one. (From Scudder's 

Fractures. Courtesy W. B. Saunders Co.) 



Fig. 302.—Fractured leg dressed with a pillow and side splints, com¬ 
plete, with straps and towels, to prevent pressure on the front of 
leg. (From Scudder’s Fractures. Courtesy W. B. Saunders Co.) 




















Fig. 303.—Fracture box for fracture of the leg with pillow and pad 
under the heel and foot. (From Da Costa’s Surgery. Courtesy 
W. B. Saunders Co.) 



Fig. 306.—Dressing for Pott’s fracture. (Fracture of the fibula near 
ankle joint.) Note the length of splints, straps, and amount of 
padding. (From Scudder’s Fractures. Courtesy W, B. Saun¬ 
ders Co.) 



















PREVENTION OF DISEASE AND CARE OF SICK. 


267 


which extends from above the knee to well above the heel. The 
method of applying this splint and the padding is best understood 
from examining figures 306 and 307. Note carefully that it is neces¬ 
sary to turn the foot strongly in by bandages or appropriate strips of 
muslin (fig. 307). The splint should be worn for five weeks and then 
the patient may be allowed to walk on crutches for a week, using a 
cane after that. 

FRACTURES OF THE BONES OF THE FOOT. 

These are usually due to direct force and are often compound. 

Symptoms. —There is a great pain in the foot on attempts to walk 
and crepitus may be produced on gently manipulating the injured 
bone. 

First-aid treatment. —The other bones act as splints and usually 
nothing will be required except to lay the foot on a pillow. 

After treatment .—Put the patient in bed, apply cold compresses for 
several days to reduce swelling. Then reduce any obvious deformity 
and apply a splint of thin wood or heavy pasteboard to the bottom 
of the foot. The sole of the shoe is used as a pattern in cutting out 
the splint. Pad it and bandage in position, leaving the toes out in 
order to observe the circulation. The dressing should be worn for 
four weeks. 

FRACTURES OF THE TOES. 

First-aid treatment. —A light splint may be applied to the sole of 
the foot, but usually no splint will be necessary. 

After treatment. —The injured toe may be bandaged to the adjoin¬ 
ing toe or a light splint may be applied which covers the entire sole. 
The dressing should be worn for three weeks, during which time the 
patient does not walk on the affected foot. 

COMPOUND FRACTURES. 

Compound fractures have already been described as fractures which 
are complicated by wound extending down to the broken bones. 
It is possible to break a bone and receive a wound of the skin or a 
wound in some other part of the limb, but if the w ound does not com¬ 
municate with the fracture it is not a compound fracture. 

Symptoms. —The symptoms are the same as those of any other frac¬ 
ture, with the addition of the wound (fig. 308). In severe cases the 
end of the broken bone may come through the wound and project on 
the outside. 

First-aid treatment. —The great aim of the treatment of compound 
fractures is to prevent bacteria getting into the wound. If pus germs 
gain admission there will be a great deal of swelling and inflamma- 

40071 °—23 - 22 



268 


PREVENTION OF DISEASE AND CARE OF SICK. 


tion and finally suppuration. The healing of the fracture will be 
prolonged for many weeks and sometimes there is so much destruc¬ 
tion of the bone by inflammatory processes that healing does not 
take place at all until surgical measures are employed. Therefore, 
in a compound fracture, always cover the wound with a sterile dress¬ 
ing at the earliest possible moment. After the wound has been cov¬ 
ered, splints may be applied as in the manner already described. 
In case a sterile dressing is not available, the wound should be 
allowed to remain exposed to the air while one is being prepared. 
A suitable dressing made of muslin or toweling may be folded into 
shape and boiled, as described on page 186. After this dressing has 
been placed on the wound and fastened in place then apply the splints. 

If one of the bones is sticking out through the flesh, the question 
arises as to whether it is wise to attempt to restore it to its natural 
place. If a doctor can be obtained in a short time, make no such 
effort, but apply the dressing over the open wound and prevent fur¬ 
ther motion of the fragments as well as may be with the splints. 
If the patient will have to be transported for a considerable distance 
before he can reach medical help, it may be proper to attempt to 
replace the bone by pulling on lower end of the limb in the direction 
of- its long axis. Before doing this, in all cases the wound and the 
protruding end of the bone should be thoroughly painted with 
tincture of iodine and all visible dirt removed from the bone, so as 
to lessen as much as possible the danger of dragging live bacteria 
into the deeper tissues. If tincture of iodine is not available, do not 
attempt to replace the protruding fragments. 

After treatment .—The after treatment of a compound fracture 
consists in removing the temporary splints and dressings and en¬ 
deavoring to free the wound from germs by swabbing it with one- 
half strength tincture of iodine very thoroughly and with great 
care, working the iodine into all parts of the wound. The operator 
should especially prepare his hands before undertaking this task, 
and every precaution should be taken against accidentally contami¬ 
nating the wound while it is being cleaned or dressed. If the bones 
are protruding, they must be very thoroughly treated with iodine 
before efforts are made to replace them in their proper position. If 
particles of dirt can be seen either in the wound or on the bone, 
they must be removed preferably by rubbing them off either with 
• the swab or small rolls of sterile gauze. After the wound and a 
wide area of the surrounding skin has been painstakingly treated 
with the iodine as above described the bone should be set and the 
wound dressed with sterile gauze. When the wound has been se¬ 
curely covered, proper splints are applied, but leaving them open 
in such a way that it is possible to re-dress the wound without dis- 


"SV//, 



Fig. 307.—Dressing for Pott’s fracture, complete. Note the method 
of turning in foot by fastening bandage to slots in the bottom 
of splint/ (From Scudder’s FractureSo Courtesy W. B. Saun¬ 
ders Co.) 




Fig. 309.—Plaster cast for compound fracture, (Cast ha- 
two openings, and a drainage tube is inserted through the 
leg. Provision is also made for suspending the leg. (Fron 
Da Costa’s Surgery. Courtesy W B. Saunders Co.) 


Fig. 308. —Compound fracture. (From 
Da Costa’s Surgery. Courtesy W. B. 

Saunders Co.) 


















Fig. 310.—Plaster cast for compound fracture reinforced with strips of 
metal. (From Da Costa’s Surgery. Courtesy W. B. Saunders Co.) 





Fig. 311.—Strapping sprained ankle with adhesive plaster. (From Da Costa’s Sur 

gery. Courtesy W. B. Saunders Co.) 































PREVENTION OF DISEASE AND CARE OF SICK. 269 

turbing the splints. Plaster of Paris bandages, with windows cut 
in them or divided into two parts which are held rigid by means 
of loops of wire or strips of metal, are the dressings usually applied 
by surgeons (figs. 309 and 310). The dressings on the wound must be 
changed as often as they become soaked with wound discharges. 
Iodoform gauze is an excellent dressing for compound fractures. 
If the wound is stitched or otherwise closed, a wick composed of 
about a dozen strands of boiled threads should be inserted into the 
bottom of the wound and left there to assist in the drainage. If the 
w T ound does not become inflamed this can be removed after 48 hours. 
If the wound does become inflamed, the wick must be left in longer. 
A piece of a boiled soft-rubber catheter makes an excellent means of 
drainage and should be used instead of the wick if it is available. 

If a doctor can be obtained in three or four days, devote most of 
the treatment to the wound, resting the part on a pillow in the 
meantime and keeping it in as good position as possible with light 
splints. Wet compresses must not be applied to compound frac¬ 
tures at first, as they will greatly increase the chances of inflam¬ 
mation. 

The diet of a patient with a compound fracture should be light 
but nutritious, using milk and eggs freely if they are obtainable. 
If inflammation and much discharge sets in. treat the wound accord¬ 
ing to the principles laid down under the treatment of inflamed 
wounds (p. 194). 

EFFECTS OF HEAT AND COLD. 

SUNBURN. 

Sunburn is a red and painful condition of the skin due to exposure 
of the surface of the body to the rays of the sun. 

Treatment .—Make a lotion as follows: Take one-half a pint of 
hot water and stir into it a level tablespoonful of boric-acid powder; 
then add 20 drops of carbolic acid, and shake well. The solution 
should be dabbed on the inflamed skin with a small piece of cotton 
or sprayed on Tvith an atomizer. It should not be rubbed into the 
skin. It can be applied every half hour if necessary. If no medi. 
cine is available cold compresses will give relief to badly burned 
areas. 

BURNS AND SCALDS. 

Description .—Burns w :e produced by dry heat, such as a flame or 
a hot iron, while scalds are flue to moist heat as. for example, steam 
or hot water. The gravity of \ burn depends upon its situation, the 
amount of surface involved, and the depth of tissue injured. The 


270 


PREVENTION OF DISEASE AND CARE OF SICK. 


burning of a large area, even though slight, is more dangerous than 
a small deep burn. Burns of the head, chest, or abdomen are more 
serious than those of the limbs. Burns involving more than one-half 
of the surface of the body almost always end fatally. In severe or 
extensive burns there is almost always shock, which requires special 
treatment before the burns are dressed (p. 220). 

When the clothing is on fire, the best way to extinguish it is to wrap 
the person in a blanket, overcoat, mackintosh, or a rug or piece of 
carpet, and smother out the flames. If the person is alone, he should 
wrap himself up in a similar way or roll on the floor. The method of 
carrying an unconscious person from a burning building is described 
on page 304. 

Treatment .—Of slight or small burns or scalds. 

As soon as the injury is received plunge the part in cold water, pref¬ 
erably ice water. This checks the action of the heat and instantly 
stops the pain. If boiling water or soup is spilled over the leg or foot, 
do not wait to remove the clothing but thrust the entire part into a 
bucket of water or pour cold water freely over it. Keep submerged 
in cold water, or covered with a cold-water dressing, which is fre¬ 
quently renewed for 20 minutes to a half hour, depending upon the 
severity of the injury. Then apply a permanent dressing. There are 
many ways of treating burns, all of which have their advocates. 

A very satisfactory dressing is plain vaseline or petroleum molle. 
This is spread with a knife on clean pieces of old muslin, gauze, or 
similar material, just as butter is spread on bread. The prepared 
cloth is then cut into strips and the strips laid on the burns “ but¬ 
tered ” side down. The' plan of using several or more small strips 
is better than applying one large piece, as the smaller dressings come 
off much more easily when the bum is re-dressed. A thin layer of 
cotton may be applied over the muslin or gauze to protect the part 
from injury and the entire dressing held in place by a suitable band¬ 
age. Never , under any circumstances , apply cotton directly to a burn. 
A good deal of fluid exudes from a burn, and this fluid will harden in 
the cotton and cement it firmly to the surface of the wound so that 
it can not be removed without great pain and interference with the 
healing process. 

Blisters may be opened by a needle, the point of which has been 
passed through a flame. The dressings should be removed at the end 
of 24 hours and fresh ones applied. Every household should keep on 
hand a large jar of vaseline for the purpose of dressing burns. Boric- 
acid ointment makes a most excellent dressing for injuries of this 
sort. A substitute is made by thoroughly mixing 1 part of boric 
acid with 10 parts of petroleum molle or vaseline. In the absence of 
vaseline use sweet oil, olive oil, castor oil, or some of the many prep- 


Fig. 312.—Spreading muslin with vaseline as a dressing for 

burns. 

i 






























Fig. 315.—Schaefer method of artificial respiration, step one. 
Throwing weight on patient’s back to force air out of the 
lungs. 



Fig. 316.—Schaefer method of artificial respiration, step two. 
Removing weight from hands on patient’s back so that air 
may enter lungs. 



Fig. 319.—Method of getting water out of the lungs of 
drowned person. 

















271 


/ 


PREVENTION OP DISEASE AND CARE OF SICK. 

* r . 7r*. * „ ' •‘jf' • ' *** “* **. 

arations of liquid petrolatum now so extensively advertised for the 
cure of constipation. In emergencies automobile grease or cylinder 
oil may be used, but always put the medicine on the dressing and then 
lay that on the wound rather than to attempt to spread the medicine 
on the surface of the burn itself. Carbolized vaseline should never 
be used on a burn, as the carbolic acid, if of any considerable strength, 
is apt to cause extensive sloughing of the part and deep ulcers, which 
are extremely difficult to heal. The picric-acid treatment for burns 
has been highly recommended and is much used, but its use should 
be restricted to limited burns of a rather mild degree. Some first- 
aid kits contain picric-acid gauze, which is first wet and then applied 
as a compress. Carron oil was formerly much used and is composed 
of equal parts of linseed oil and limewater. It is not as good as 
vaseline or pertoleum molle and has the objection of soaking through 
the dressings and soiling the bed or clothing. 

SEVERE EXTENSIVE BURNS. 

First-aid treatment .—These require the attention of a physician if 
available. Such injuries are always accompanied by shock (p. 220), 
and they should be treated by absolute quiet, covering the patient 
with blankets or warm clothing, applying hot-water bags and the 
administration of stimulants such as hot strong black coffee, half a 
teaspoonful of aromatic spirits of ammonia in a little water. It may 
be necessary to give one-fourth grain of morphine sulphate or some 
preparation of opium to allay the pain. Do not place horse blankets 
next to the skin on account of the danger of lockjaw. 

After treatment .—When the patient has reacted from shock, the 
clothing should be removed carefully, cutting it around the places 
where it sticks to the flesh. If patches of hot tar or some sticky sub¬ 
stances are adherent to the skin, do not try to remove them, but place 
the dressing over the foreign substances. They will gradually loosen 
up and come off. Cover the burned areas with strips of gauze or 
clean muslin spread with vaseline, boric-acid ointment, or petroleum 
molle, as described for slight burns. Place a layer of cotton over the 
gauze and keep the dressing in place with a suitable bandage. The 
dressing is removed once a day and the burned surface irrigated 
with a tepid solution of boric acid made by adding a heaping table¬ 
spoonful of the boric acid to a pint of hot water. Salt solution in 
the proportion of a teaspoonful of salt to a quart of boiled water may 
also be used. After the surface has been thoroughly irrigated, apply 
a fresh dressing as before. Great care should be exercised in han¬ 
dling such cases, and the dressings removed with great gentleness, 


272 


PREVENTION OF DISEASE AND CARE OF SICK. 


for the pain and shock caused by this procedure, if roughly done, 
may materially affect the patient’s chances for recovery. 

In extensive burns the complete submergence of the part in a 
warm solution composed of 1 teaspoonful of salt to a quart of water 
will give good results. In the case of children who have very ex¬ 
tensive burns it is sometimes practicable to place them in a bathtub 
partially filled with the above solution, supporting them on rubber 
air pillows and covering them with blankets. All parts may be 
kept completely submerged in this fashion, except the head, for 
several days, hence the continuous attendance of a nurse, both day 
and night, is required to see that the bath is kept at the proper tem¬ 
perature and that the child does not drown. In burns of the fingers 
and toes it is necessary to keep dressings between the burnt members 
during the healing process, or otherwise the fingers or toes may grow 
together. After all extensive burns tough scars will form, which 
gradually contract, and extensive permanent deformities may result. 
A person who has been extensively burned should receive a light 
but nutritious diet, preferably of soup, milk, and eggs. The bowels 
should be kept open and care should be taken to empty the bladder 
with a catheter in case the urine is not voluntarily passed. 

Mixtures of paraffin with other oils and substances have been re¬ 
cently much advocated for the treatment of burns, especially abroad. 
The preparation, which is solid when cool, is melted and sprayed 
on the burned surface with an atomizer or it may be applied with a 
soft brush. Then a layer of cotton batting is applied to the bum and 
more of the warm paraffin mixture sprayed over it. The protective 
dressing is removed once a day, the surface irrigated with some weak 
antiseptic solution, dried with compresses of gauze, and another 
application put on. A preliminary coat of liquid petrolatum dimin¬ 
ishes the pain of spraying the hot solution onto the injured surface. 
This method of treatment has not been as highly indorsed in this 
country as in Europe, and the technique and the apparatus required 
for dressing burns in this way is probably too complicated for the 
use of the layman. 

BURNS FROM CHEMICALS SUCH AS STRONG ACIDS OR ALKALIES. 

These substances, when coming in contact with the skin, frequently 
cause burns similar in many respects to those produced by heat. 
The chemical should be immediately washed off as quickly as pos¬ 
sible with a stream of running water. It is rarely advisable to 
attempt to counteract the substance with some other chemical, as 
the proper materials for this purpose are not often at hand, and if 


PREVENTION OF DISEASE AND CARE OF SICK. 


273 


freely flowing water is used the same effect can be produced in this 
manner. After prolonged washing dress the burn in any of the 
methods as described above. 

' BURNS FROM CARBOLIC ACID. 

The skin is frequently injured by accidental contact with carbolic 
acid. This substance is more easily removed by some form of alcohol 
than in any other way. Pure alcohol is best, but if it can not be 
obtained, whisky, brandy, or any other beverage containing alcohol 
should be freely and continuously poured over the part. Do not. 
however, use wood alcohol. While waiting to obtain a preparation 
containing alcohol, cold water will be of assistance in getting rid of 
the carbolic acid. 

BURNS OF THE EYE BY CHEMICALS. 

Frequently various caustic substances get into the eye, especially 
lime in making mortar. The treatment is to wash the eye freely 
with cold water. In order to do this the patient should be laid on 
the ground, the eyelids held open by the fingers, and the water poured 
into the eye from a pitcher, can, or other container. Use plenty of 
w T ater and wash thoroughly, being sure that it actually gets into the 
eye. After the chemical is removed a few drops of a saturated solu¬ 
tion of boric acid should be put into the eye. In the absence of boric 
acid a few T drops of sweet oil or olive oil may be used. 

ELECTRIC BURNS. 

When a person comes in contact w r ith a live electric wire, severe 
and deep burns are frequently produced. 

Treatment .—Electric burns should be dressed for several days with 
w r et dressings of boric acid solution (p. 187), afterwards with dry 
gauze lightly spread with vaseline. Such burns are always very slow 
in healing. 

SUNSTROKE AND HEAT EXHAUSTION. 

(For the symptoms and treatment of sunstroke and heat exhaus¬ 
tion see p. 160.) 


EFFECTS OF COLD. 

t 

By Assistant Surgeon Genei*al W. G. Stimpsow. 


FROSTBITE. 

Symptoms .—The local effects of cold are, according to their sever¬ 
ity., usually divided into three degrees. In the first degree the part 
is painful and the skin is of a dark red hue. This condition is known 
as chilblain, and occurs chiefly when children or poorly nourished 
persons are exposed to cold. In frostbites of the second degree the 
skin is of a bright red or livid hue and blisters form on its surface. 
In the third degree the part is pale, stiff, and brittle. Severe cold 
causes constriction of the blood vessels, and if the blood is completely 
cut off for a considerable time death of the tissue results. 

If heat is applied to a part that has been slightly frostbitten a sen¬ 
sation of itching and tingling is experienced. In frostbites of the 
second degree heat causes pain and swelling. The skin may peel off, 
leaving a raw surface. In the third degree, if the part is dead no 
reaction takes place. The dead portion turns black, and a line of 
separation takes place between it and the living tissue. If heat is . 
suddenly applied to a badly frozen part of the body the liability to 
gangrene (death of the tissue) is increased on account of the intense 
reaction that takes place in the tissue that is still living. 

When the whole body is exposed to severe cold the individual be¬ 
comes benumbed, exertion is difficult, and drowsiness which can not 
be resisted overtakes him. The eyesight fails, he totters as he walks, 
and then falls and becomes unconscious. 

Prevention .—All parts of the body should be kept as dry as pos¬ 
sible, as dampness increases the tendency to frostbite. The shoes 
should be large, and puttees or leggings should be worn loose in 
order not to impede the circulation of the blood. Tight garters must 
not be worn. It is well to wear two pairs of stockings, a woolen pair 
over a cotton pair. The ears and the face, except the eyes, nose, and 
mouth, should be well covered, especially if snow is falling or a 
brisk wind is blowing. Fur-lined gloves are warmer than woolen 
ones. Special care should be taken of the feet; they should be washed 
each day and a small quantity of oil should be rubbed into them. 

A large amount of oil does harm; only enough should be used as 
can be well rubbed in, leaving a dry surface when the rubbing is 
completed. Clean stockings should be put on each day. Wet stock- 
274 



PREVENTION OF DISEASE AND CARE OF SICK. 275 

ings should be changed for dry ones. If a person has to be on duty 
with wet feet an opportunity should be afforded him to put on dry 
stockings at least every six hours. The feet are less likely to become 
frostbitten if a person keeps moving. If he has to stand in one place 
shoestrings and puttees should be loosened. 

Treatment .—If a physician is present, his instructions should be 
followed. If the frostbite is of the first degree^—that is. if the 
tissue is only slightly frostbitten—the part should be gently 
rubbed, and cloths wrung out of cold water should be applied. 
Snow may be rubbed on the part, but it is not as efficient as cold 
cloths. The rubbing and the applications should alternate, rubbing 
a few minutes, and then applying cloths for a few minutes. The 
temperature of the water in which the cloths are soaked should be 
gradually raised until it is lukewarm. In frostbites of the second 
degree—that is, where the skin is of a livid hue and blisters have 
formed—no rubbing should be practiced, as there is danger of in¬ 
creasing the damage. Cold cloths should be applied, but the cold 
must not be kept up too long, as cold prolongs the cause of the injury. 
The temperature of the water should be gradually raised a degree 
or two every few minutes, using fresh cloths each time the temper¬ 
ature of the water is changed. It should be remembered that re¬ 
action takes place naturally as soon as the person is brought into 
*he house out of the cold, even if he is treated in a cold room, and 
the object of treatment is to prevent this reaction from taking place 
too rapidly and at the same time not unduly retard the restoration of 
vitality. In frostbites of the third degree the same method should 
be followed to bring about a reaction as in those of the second degree; 
reaction, however, will not happen in a part that is dead, but the 
adjacent living tissue will react, and a red line will form between 
it and the dead portion. 

In some cases reaction has already taken place when the person is 
first seen. In these cases the above treatment is unnecessary. After 
reaction has occurred the patient should be moved into a warm room, 
and an ointment composed of vaseline 1 ounce, camphor 6 grains, 
should be applied. The part should then be surrounded with ab¬ 
sorbent cotton or wrapped in flannel cloths. Boraeie acid ointment 
may be used instead of the vaseline and camphor. Blisters that form 
should be pricked with a needle and the water allowed to flow out, 
but the covering of the blisters should not be disturbed. If gan¬ 
grene occurs, cloths wet with alcohol placed over the part prevent 
infection and hasten the separation of the dead part from the living 
tissue. 

A person who has been exposed to a low temperature or submerged 
in cold water should be placed in a cold room, and artificial respi¬ 
ration should be performed. The extremities should be rubbed with 




276 PREVENTION OF DISEASE AND CARE OF SICK. 

a solution composed of equal parts of alcohol and water. When the 
patient begins to react the temperature of the room should be slowly 
raised, and the patient should be given hot drinks, coffee, tea, or 
chocolate. If the patient is unable to swallow, a pint of hot coffee 
or tea should be injected into the rectum. Efforts to restore anima¬ 
tion should be continued for an hour or two, as persons have been 
brought to life after being apparently dead. 

SUFFOCATION. 

It is necessary that fresh air should be constantly entering the 
lungs and used air expelled if life is to be maintained. When this 
process is stopped or markedly obstructed suffocation results. 

Most cases of suffocation are treated by removing the direct cause 
and performing artificial respiration. To do this properly the opera¬ 
tor should have some knowledge of the respiratory system. 

Respiration .—All parts of the body require oxygen which is car¬ 
ried to them by the circulating blood. The blood gets its oxygen 
while passing through the lungs from the inspired air. The tissues 
also form a harmful gas called carbon dioxide, which is collected 
by the blood and given off in the lungs and then expelled in the breath. 
Breathing, or respiration, consists of inspiration and expiration. 
Inspiration is the act of drawing fresh air into the lungs, and expira¬ 
tion is the process of forcing the used air out. The normal adult 
breathes at the rate of 18 times a minute. 

Respiratory system .—The nose, mouth, windpipe, and lungs con¬ 
stitute the respiratory or breathing apparatus. The lungs are two 
large spongy organs or sacs in which the blood is brought into close 
contact with the air so that oxygen may be absorbed and impurities 
given off. The lungs lie closely against the chest walls and rest below 
on a thin partition of muscle extending across the body called the 
diaphragm. The diaphragm separates the main cavity of the trunk 
into compartments. The upper space contains the heart and lungs, 
the lower the stomach, intestines, and other internal organs. The 
chest walls are somewhat movable, and when they are pressed to¬ 
gether a part of the air is forced from the lungs. When they are 
allowed to spring up again the size of the cavity increases and fresh 
air is drawn in. Respiration in a normal person is carried on chiefly 
by the contraction of the diaphragm, assisted by the movements of 
the chest walls. In artificial respiration the entrance and exit of the air 
is produced by alternately forcing the chest walls nearer together by 
pressure on the chest or back and then releasing them so that they 
may spring back to their original shape. 

Method of performing artificial respiration .—There are two meth¬ 
ods of artificial respiration in common use, but only the Schaefer, or 


PREVENTION - OF DISEASE AND CARE OF SICK. 277 

the prone-pressure method, will be described, because it is believed to 
be the more efficient, and it is certainly easier to perform. 

Before starting artificial respiration always remove the cause of 
suffocation. This may be water in the lungs, or an obstruction in or 
around the throat, or contact with an electric current. In the case 
of persons overcome by gas, remove to fresh air. 

The Schaefer method .—The collar is removed and shirt band 
loosened. The patient is laid on the ground, face downward. The 
arms may be raised about the head, one arm flexed so that the fore- 
head rests upon it. The face must be turned slightly to one side, so 
that the nose and mouth will not be closed by pressure against the 
ground. The operator stands or kneels astride of the patient and 
places his hands close together, one on each side of the backbone at 
about the region of the short ribs—that is, about the middle of the 
body. The operator now leans forward (fig. 315) and throws his 
weight on his hands, which are against the back, thus pressing 
the lower part of the chest against the ground and also to a cer¬ 
tain extent forcing the belly contents up against the diaphragm. 
The effect of this double procedure is to decidedly diminish the 
capacity of the chest and air is forced out. The pressure is ap¬ 
plied firmly but gently, and then removed by the operator bending 
his body backward and taking the weight off his hands (fig. 
316). The removal of pressure causes the chest to expand and 
the organs of the abdomen to recede by their own elasticity, and 
this expansion of the chest cavity draws air into the lungs 
through the windpipe. The operator pauses for about three seconds 
to allow the fresh air to become mixed with the blood and then 
repeats the process. These alternate procedures of compressing 
the chest and then relieving it and pausing for three seconds are con¬ 
tinued rhythmically until the patient begins to breathe himself. The 
movements are performed at the rate of about 12 to 14 times per min¬ 
ute. It takes about a second before the air is all out and a second for 
it to enter, and the three seconds' pause makes it a total of five seconds 
for the complete cycle. The hands should remain in the proper posi¬ 
tion upon the back after the pressure has been removed, but no weight 
should be placed upon them. The operator swings his body back¬ 
ward and forward with the least possible exertion, and on this ac¬ 
count is able to keep up the movements for a long time without undue 
fatigue. It may be necessary to perform artificial respiration for 
several hours, or even longer. In rare instances it has been kept up 
more or less continually for several days. In any event, it should 
be tried for at least an hour and a half. A good rule is that artificial 
respiration in suffocation cases should be performed until it is certain 
that the individual is dead, and then continued for an hour and a 
half longer. Many persons who were apparently lifeless have been 
finally restored by long-continued efforts. 


278 


PREVENTION OF DISEASE AND CARE OF SICK. 


When the air enters and leaves the chest it makes a very audible 
sound in passing through the paralyzed throat. If this sound is not 
heard it may be inferred that the method is not being properly 
applied. 

When the patient begins to breathe voluntarily in a regular manner, 
he should be turned on his back and suitable measures toward keeping 
him warm applied. Later on when he is conscious and can swallow, 
stimulants are administered such as hot black coffee or aromatic 
spirits of ammonia. The limbs should be vigorously rubbed toward 
the heart to assist in restoring the circulation and bringing up the 
body warmth. If vomiting occurs, turn the head to one side so that 
the vomited matter will run out of the mouth and not get back into 
the lungs. W 7 hen breathing is fully established and the general con¬ 
dition good, the patient should be put in bed warmly covered and if 
ho is cold external heat applied. Care should be taken to see that he 
has plenty of fresh air. 

Various mechanical devices, such as pumps or bellows, connected 
with face masks or similar appliances, have been devised for the pur¬ 
pose of performing artificial respiration. Many of these machines 
have been widely advertised and highly recommended. A more ex¬ 
tended trial, however, has demonstrated that some of them are not 
entirely satisfactory and their use is occasionally followed by unde¬ 
sirable complications. Further developments along these lines may 
succeed in producing an apparatus, however, which will be free from 
any defects. 

After natural breathing begins the patient must be carefully 
watched because it may fail and artificial respiration be again 
necessary. 

In all cases of suffocation send for a doctor, if available, but do not 
wait for his arrival before starting artificial respiration. This should 
be commenced immediately as a few moments’ delay may mean the 
loss of a life. The method of performing artificial respiration is the 
same in all cases of suffocation. 

Causes of suffocation .—These are submergence of the body in 
water, the breathing of certain gases, a foreign object in the throat, 
strangulation, and sometimes swelling of the upper air passages. 

Symptoms of suffocation .—When a person for any reason is not 
getting sufficient fresh air the face becomes blue or almost black, the 
veins stand out and he fights frantically for breath. If relief is not 
obtained, the efforts to secure air become more violent and the duski¬ 
ness of the face increases. Convulsions may occur but finally uncon¬ 
sciousness sets in to be followed shortly by death. A person who has 
been apparently dead from suffocation for several minutes or longer 
may frequently be revived if the cause is quickly removed and artifi¬ 
cial respiration immediately started. 


1 


PREVENTION OF DISEASE AND CARE OF SICK. 279 

DROWNING. 

Prevention. —Ordinary care and caution will do much to prevent 
accidents in the water. Inexperienced persons should not attempt to 
handle sailboats or even rowboats. Pleasure craft should not be over¬ 
loaded nor attempts be made to change seats in small boats except 
with great caution. 

The swimmer should be careful not to overtax his strength, not to 
remain in the water too long, or to get so far out that he might be 
caught by the undertow. Every child should be taught to swim, and 
all parents should appreciate the necessity of their children being 
given this training. 

Rescue of drowning persons. —If possible, do not attempt to rescue a drown¬ 
ing person in deep water by entering the water yourself. The best interests of 
the drowning person are served, when practical, by holding out or throwing some¬ 
thing into the water on which he can support himself till he can be pulled ashore 
or reached in a boat. In case a person has fallen into deep water near the shore 
take an oar, a pole, a rope, or even your coat and hold it out so the drowning 
person may grasp it. Life preservers, boxes, boards, or logs may also be 
thrown into the water close to the person drowning. As has been stated above, 
a small, floating object is quite sufficient to sustain a person’s weight in the 
water.— American Red Cross Abridged Text-Book on First Aid. 

INSTRUCTIONS FOR SAVING DROWNING PERSONS BY SWIMMING 

TO THEIR RELIEF. 

(From the Handbook For the Ship’s Medicine Chest.) 

1. When you approach a person drowning in the water, assure him, with a 
loud and firm voice, that he is safe. 

2. Before jumping in to save him, divest yourself as far and as quickly as 
possible of all clothes; tear them off, if necessary; but if there is not time, 
loose at all events the foot of your drawers, if they are tied, as, if you do not 
do so, they fill with water and drag you. 

3. On swimming to a person in the sea, if he be struggling, do not seize him 
then, but keep off for a few seconds till he gets quiet, for it is sheer madness 
to take hold of a man when he is struggling in the water; and if you do, you 
run a great risk. 

4. Then get close to him and take fast hold of the hair of his head, turn 
him as quickly as possible onto his back, give him a sudden pull, and this will 
cause him to float, then throw yourself on your back also and swim for the 
shore, having hold of his hair, you on your back and he also on his, and, of 
course, his back to your stomach. In this way you will get sooner and safer 
ashore than by any other means, and you can easily thus swim with two or 
three persons. One great advantage of this method is that it enables you to 
keep your head up, and also to hold the person’s head up you are trying to 
save. It is of primary importance that you take fast hold of the hair and 
throw both the person and yourself on your backs. After many experiments, 
it is usually found preferable to all other methods. You can in this manner 
float nearly as long as you please, or until a boat or other help can be ob¬ 
tained. 

5. It is believed there is no such thing as a death grasp; at least it is very 
unusual to witness it. As soon as a drowning man begins to get feeble and to 

49671°—23-23 



I 


280 PREVENTION" OF DISEASE AND CARE OF SICK. 

lose his recollection, he gradually slackens his hold until he quits it altogether. 
No apprehension need, therefore, be felt on that head when attempting to 
rescue a drowning person. 

6. After a person has sunk to the bottom, if the water be smooth, the exact 
position where the body lies may be known by the air bubbles, which will 
occasionally rise to the surface, allowance being, of course, made for the 
motion of the water, if in a tideway or stream which will have carried the 


RESCUE METHODS 

Rucuur thould not go into the water unleu Neceuary but thould u^e a Line, Buoy or Boat 



Fig. 317.—Saving drowning persons. (Courtesy American Red Cross.) 


bubbles out of a perpendicular course in rising to the surface. Oftentimes a 
body may be regained from the bottom before too late for recovery by diving 
for it in the direction indicated by these bubbles. 

7. On rescuing a person by diving to the bottom the hair of the head should 
be seized by one hand only and the other used in conjunction with the feet in 
raising yourself and the drowning person to the surface. 

8. If in the sea, it may sometimes be a great error to try to get to land. If 
there be a strong “ outsetting ” tide, and you are swimming either by yourself 




















































































































































































PREVENTION' OF DISEASE AND CARE OF SICK. 281 

or having hold of a person who can not swim, then get on your back and float 
till help comes. Many a man exhausts himself by stemming the billows for the 
shore on a back-going tide and sinks in the effort, when if he had floated, a 
boat or other aid might have been obtained. 

9. These instructions apply alike to all circumstances, whether as regards the 
roughest sea or smooth water. 


BREAKING DEATH GRIPS 



1. When Rescuer U Held by Wrists _ _ " T ~ 


2. When Rescuer is Clinched around the Neck 
RESTORING NEARLY DROWNED 



3. When Rescuer is Clutched around 
the Body or Arms 


2. Artificial Respiration (B) 


Fig. 318.—Saving drowning persons. (Courtesy American Red Cross.) 


The popular idea that a drowning person rises to the surface three 
times is apparently incorrect. Some persons never come to the 
surface at all. Others come up but once, so no assumption should 
be made that the rule of coming up three times will always hold true. 

When a person has been brought to land or other safe place, if he 
is unconscious, the first procedure is to get the water out of the 
lungs. To do this roll him on his face, stand astride of the hips, and 
clasp the hands under the lower part of the abdomen. Lift up the 













































































































































































































282 


PREVENTION OF DISEASE AND CARE OF SICK. 


hips and abdomen by straightening the back. This will cause the 
head to be lower than the lungs and the water will run out of the 
mouth (fig. 319). Hold in this position for a few moments, or as 
long as the water runs out of the mouth, giving the body several 
slight shakes. Then sweep the finger into the mouth to see that 
the throat is not clogged with sand, seaweed, or other matter, remove 
tight clothing from around the neck or throat and begin artificial 
respiration immediately. It is not necessary to roll an apparently 
drowned person over a barrel to get the water out of him. Attempts 
at resuscitation on a beach should not be made with the part of the 
body submerged in the water or in such a position that a wave may 
sweep over the unconscious person. It is better to drag him well up 
where he will be dry and out of danger. 

Artificial respiration on apparently drowning persons should be 
carried out as directed on page 277. As soon as the person is revived 
and the breathing is satisfactory, he should be taken to some warm 
place, the extremities rubbed, and suitable general remedies ad¬ 
ministered. 

ELECTRIC SHOCK. 

Many of the wires strung about city streets carry powerful electric 
currents. If such wires become broken or sag down, passers-by may 
come in contact with them and receive severe and possibly death¬ 
dealing shocks. 

Prevention .—Broken wires of any sort dangling from their poles 
should not be touched. They may carry dangerous currents them¬ 
selves or be temporarily charged, because they are somewhere resting 
on live wires. 

Symptoms .—In severe electric shock there is sudden loss of con¬ 
sciousness, the breathing is apt to be entirely arrested, and the pulse 
weak. Burns may be caused by the arcing of the current where the 
wire has touched the body. 

Treatment .—The first thing to be done is to break the contact of 
the person with the wire or third rail; great care must be exercised 
in doing this or the helper may be as badly injured as the original 
victim. The body of a person lying upon a conductor is fully 
charged with the electricity, and it is dangerous to touch it with 
bare hands unless the body of the assistant is thoroughly insulated. 
The coat, however, may be grasped, and possibly the injured person 
can be dragged from the wire in this manner without actually touch¬ 
ing the flesh. If absolutely necessary to take hold of the body, wrap 
the hands in several thicknesses of dry cloth, rubber sheeting, or dry 
newspapers, and stand on a dry board or other nonconductor if 
possible. 


PREVENTION OF DISEASE AND CARE OF SICK 


283 


A live wire may be removed from an unconscious person by lifting 
it off with a dry pole, wooden walking stick, or some similar article 


HOW TO RESCUE PERSON FROM CONTACT WITH ELECTRIC CURRENT 
(When possible the rescuers should Stand on Dry Wood or Cloth) 



Fig. 320.—Electric shock. (Courtesy American Red Cross.) 

made of wood, which is a nonconductor. The wood must be dry, 
however. The person endeavoring to perform the rescue should in 


























284 


PREVENTION OF DISEASE AND CARE OF SICK. 


all cases stand on a dry board if it is obtainable. A number of 
newspapers, or the operator’s folded coat will answer the same 
purpose in an emergency. Bubber overshoes and heavy rubber gloves 
furnish good protection. If the powerhouse is near or there is a 
switch in the locality, it may be better to attempt to have the cur¬ 
rent turned off rather than to try other procedures. If the live wire 
is so twisted around the body that it is necessary to cut it, use an 
ax or hatchet with a wooden handle. Be careful that the cut end 
does not strike the operator. 

When a wire is taken off the body or a person removed from the 
wire, this should be done with one motion if possible, because if the 
wire touches the person several times bums will be received at each 
contact. 

After the person has been removed from the current, if he is not 
breathing, artificial respiration should be immediately performed 
followed by the usual restorative measures as described on page 277. 
For the treatment of bums from electric wires, see page 273. 

GAS POISONING. 

Gas poisoning is a frequent accident, especially in the larger cities 
and towns where gas is used for illumination purposes. Various 
gases may be detrimental when inhaled for a considerable period, 
the amount of injury depending upon the nature of the substance, 
and even apparently innocuous gases, such as carbon dioxide, may' 
cause death, not by their direct action but by depriving the patient 
of air because they have replaced it, and the patient is not getting 
oxygen. Gases like ammonia or chlorine may quickly produce death 
from shock and irritation. Eecently deaths have been reported from 
the gas generated by an automobile engine running in a small 
garage which was tightly closed on a cold morning. The use of 
poisonous and irritating gases in warfare was developed to a great 
degree in the recent European war. 

Firemen are frequently overcome from the effects of smoke and 
the products of combustion from wood, varnish, and other ma¬ 
terials in burning buildings. 

By far the greater number of cases of suffocation due to gas in 
this country are caused by illuminating gas. Many persons use this 
method of committing suicide. 

Prevention .—A gas burner should never be turned down low and 
allowed to burn all night in a room in which persons are sleeping, 
as the flame may be extinguished by a change in pressure or a slight 
draft and later the room become filled with gas. When going into 
burning buildings which are filled with smoke it is well to tie a 
cloth wet with water around the nose and mouth. As the air is 
generally purer near the floor than at the ceiling, the person should* 


PREVENTION OF DISEASE AND CARE OF SICK. 285 

if necessary, walk on the hands and knees or crawl on the floor. In 
entering a room or other place which is full of gas to remove a 
suffocated person take several deep breaths of pure air outside and 
spend as brief a time in the compartment as possible. 

Symptoms of illuminating-gas suffocation .—Preliminary signs are 
headache, dizziness, nausea, feeling of sleepiness and langour, and 
a rapid pulse. In later stages when unconsciousness comes on, the 
face and hands are blue, heart action is very rapid and weak, and 
breathing may be shallow or entirely suspended. 

Treatment .—The patient should always be immediately removed 
to where the air is fresh and good. If he is only slighdy affected, 
walk him up and down in the open air and give some effervescing 
drink, such as soda water, Weiss beer, or a teaspoonful of baking 
soda in a glass of water. This will cause belching of the gas and 
relief from nausea. 

In more severe cases, when the patient is more or less unconscious 
but still breathing, sprinkle a few drops of ammonia water on a 
handkerchief and allow the patient to take one breath with this 
under his nose, once a minute. Rub the arms and legs briskly 
toward the heart to promote the circulation. If the patient is 
conscious enough to swallow, give one-half teaspoonful of aromatic 
spirits of ammonia in half a glass of water. 

If breathing has ceased, begin artificial respiration at once, after 
loosening the collar or any tight clothing around the neck and chest. 
Have an assistant give whiffs of ammonia, as described above, and 
also rub the extremities toward the heart; but do not let these pro¬ 
cedures interfere with the artificial respiration, which must be con¬ 
tinued without interruption until the patient begins to breathe of his 
own accord in a regular manner. 

The after treatment is rest in bed with appropriate stimulation. 
In severe cases the patient should be kept in bed until he has fully 
recovered, as dangerous symptoms have followed getting up too early. 

STRANGULATION AND HANGING. 

Treatment. —Remove the cause immediately. In cutting down a 
person who has attempted to commit suicide by hanging, hold the 
body in such a way that he will not be injured by the fall. Remove 
the noose and then immediately proceed to perform artificial respira¬ 
tion. The after treatment is the same as for other cases of suffocation. 

UNCONSCIOUSNESS. 

Description. —A person is unconscious when he does not realize 
what is going on around him. Unconsciousness may be complete or 
partial. In the latter case the individual can be aroused, but is not 
fully in the possession of his senses. 


286 


PREVENTION OF DISEASE AND CARE OF SICK. 


Causes of umconsciousness .—All forms of unconsciousness are due 
to a disturbance of the brain of some sort. The causes which act on 
the brain and produce this condition are many and varied. A blow 
on the head or pressure on the brain from a large blood clot or a 
depressed fracture of the skull may cause unconsciousness. A lack 
of blood supply to the brain produces the same condition as in faint¬ 
ing. Certain drugs, like opium, ether, chloroform, or large amounts 
of alcohol when circulating in the blood affect the brain and are 
followed by loss of consciousness. Such substances may be absorbed 
from the stomach or inhaled and taken up by the lungs. The system 
itself may produce poisons which are not gotten rid of and uncon- 
consciousness follows. This frequently occurs before death from 
diabetes. Finally, unconsciousness may be a symptom indicating a 
disease of the nervous system, such as epilepsy. 

An unconscious person is absolutely helpless and especially depend¬ 
ent on his friends or whoever happens to be near for aid and protec¬ 
tion from harm. However, a word of warning concerning the han¬ 
dling of unknown unconscious individuals in public places may not 
be amiss. It is not wise to follow a perfectly natural impulse to 
search the clothing or to look through the pocketbook of an uncon¬ 
scious person to ascertain his name and address. Such an act may 
be interpreted by the bystanders as an attempt at robbery, and un¬ 
pleasant complications result. These measures should be left to the 
police or other persons of recognized authority. 

GENERAL RULES FOR THE EXAMINATION OF UNCONSCIOUS 

PERSONS. 

1. Feel the pulse at the wrist and form an estimate of its rate and 
force. A rapid, weak pulse indicates a dangerous condition. A 
strong pulse, beating between 76 and 90, is a good sign. 

2. Determine whether the person is breathing or not and the nature 
of the respirations; whether they are slow or fast, deep or shallow. 

3. Note the color of the face. 

4. Observe if the skin is hot or cold and the presence or absence of 
perspiration. 

5. Examine the eyes to see if the pupils or black spots in the 
middle of the eye are small or large (figs. 322 and 323). Compare the 
two eyes to see if the pupils are of the same size (fig. 324). 

6. If the person has evidently been the victim of an accident, look 
for hemorrhage and feel the head to detect possible fractures of the 
skull. 

7. Take into consideration the surroundings and other general 
conditions. When the heat is excessive, heat strokes are a common 
cause of unconsciousness. An empty bottle near by may suggest 
attempted suicide by poisoning. Signs of a struggle might indicate 
an assault with brain injury. 



Fig. 321.—Normal pupils. 



Fig. 322.—Dilated pupils. 



Fig. 323.—Contracted pupils. 



Fig. 324.—Unequal pupils. A common symptom of apoplexy or brain 

injury. 



























Fig. 325.—Head low in fainting. 



Fig. 326.—Regular stretcher. 



Fig. 327.—Improvised stretcher made of bags. 



Fig. 328.—Blanket stretcher, 




























PREVENTION OF DISEASE AND CARE OF SICK. 287 

FAINTING. 

Fainting is a temporary loss of consciousness due to insufficient 
supply of blood to the brain. 

Some persons faint very much more easily than others. The 
tendency toward fainting does not always depend upon the physical 
strength, and strong men sometimes faint from very slight causes. 

Persons may faint from exhaustion, weakness, hemorrhage, ex¬ 
treme heat, lack of air, or some emotional shock, such as fear or the 
sight of blood. There is a very important mental element in almost 
all fainting attacks. 

Symptoms.—X feeling of weakness comes over the patient and 
black spots float before the eyes. The face becomes pale or greenish 
yellow, and the lips lose their natural color. Cold perspiration 
breaks out on the forehead. There is a tendency to yawn; the pulse 
is rapid and weak and the respirations are very shallow. Finally, 
the patient sinks back in his seat or falls to the ground unconscious. 

Treatment .—When the beginning of the attack is felt or noticed, 
it may be possible to check it by lowering the head between the knees. 
If in spite of this the symptoms continue, immediately place the 
patient in a recumbent position and lower the head. When a couch 
or bench is available, lay the person on it with the head hanging 
over the end or side. The color of the face is a good indicator of the 
blood supply of the brain. A pale face indicates a lack of blood in 
the brain. Lowering the head causes the blood to go to the brain by 
gravity. As a general rule in all accidents, if the face is pale, lower 
the head. If the face is red, raise the head on a pillow or coat. 

It is important that the fainting person should have plenty of 
fresh, cool air. This alone will often bring about recovery. Dash¬ 
ing cold water on the face or chest is useful. Smelling salts or a few 
drops of ammonia water on a handkerchief held under the nose at 
intervals of a minute apart, until the patient has taken one breath, 
and fanning the face, will assist in recovery, but ordinarily all that 
is required is a recumbent position with the head low. When the 
patient becomes conscious give one-half a teaspoonful of aromatic 
spirits of ammonia in water if available. Do not permit the person 
to get up or to attempt to walk until he or she is fully recovered. 

ACUTE ALCOHOLISM. 

The taking of large quantities of alcohol in the form of whisky, 
brandy, or other liquor will produce unconsciousness. The symptoms 
of drunkenness are familiar to most persons, but there are certain 
characteristic features which should be carefully studied in order to 
distinguish alcoholic coma from other very serious conditions with 
which it may be confounded. A drunken man may be severely in- 


288 


PREVENTION OF DISEASE AND CABE OF SICK. 


jured, may have taken poison, or have a stroke of apoplexy. In fact, 
his condition makes such accidents more likely to occur. 

Symptoms of acute alcoholism .—The first effects of alcohol are 
a peculiar feeling of well-being and exhilaration. The individual 
becomes talkative, self-assertive, and boastful. As the amount is 
increased the speech becomes indistinct, the eyelids heavy and the 
gait uncertain. Later sleepiness, stupor, and general loss of control 
of the muscles develop. Finally, the patient becomes partially or 
completely unconscious. 

When a drunken man is examined it will be found that the pulse 
is somewhat rapid but usually strong. The breathing is deep and 
slow. There is often snoring. The face may be red or pale, the skin 
cool. The pupils are equal (fig. 321) and there is an odor of alcohol 
on the breath. The individual can be generally aroused to a certain 
extent by shouting in the ear or pounding on the soles of the feet. 

Too much reliance must not be placed on the smell of alcohol on 
the breath. As before stated a drunken man may meet with an acci¬ 
dent, or an injured person may smell strongly of the liquor which 
has been administered by some sympathetic bystander. The indis¬ 
criminate giving of whisky to persons who have met with accidents 
can not be too strongly condemned. Unfortunately there appears 
to be an ill-founded popular idea that the proper procedure is to 
give a drink to every injured man. Large doses of alcohol frequently 
confuse the symptoms and later add to the general depression of the 
patient. In head injuries or in apoplexy, any form of stimulation 
is absolutely contraindicated. 

Treatment of adute alcoholism .—When a man has taken too much 
liquor the proper thing to do is to remove as much of it from the 
system as possible. If the patient is conscious the stomach should 
be emptied by an emetic or tickling the throat with the finger. As 
an emetic, use a teaspoonful of mustard or a teaspoonful of salt 
in lukewarm water. Repeat several times if vomiting is not pro¬ 
duced. Afterwards when he arouses from his stupor, give strong, 
black coffee and copious draughts of cold water. 

Sometimes drunken men are found on the street or in other places 
and it is necessary to arouse them in order to get them home or to a 
place of safety. This can be done by any severe shock such as dash¬ 
ing cold water on the face, slapping the face, or making pressure 
on the facial nerve with the forefingers under the ears just behind 
the jaws, pressing upward and inward. 

FITS. 

Fits are a symptom of a disease called epilepsy in which the patient 
goes into a more or less violent convulsion with gnashing of the teeth 
and frothing at the mouth and then falls unconscious. These attacks 


PREVENTION OF DISEASE AND CARE OF SICK. 


289 


may occur at rare intervals or as frequently as several times a day. 
The attacks differ greatly in their severity as well as their frequency. 
The period of unconsciousness may be only momentary or may con¬ 
tinue for several hours. The patient is apt to bite his tongue during 
the convulsion or to fall and injure himself by striking some hard 
object. 

treatment of the convulsion. —Do not attempt to prevent the move¬ 
ments or to break the grip as the fit can not be checked in this way. 
Lower the patient to the ground or floor and simply protect him 
from harm by gentle restraint and guard against biting the tongue 
by inserting a piece of wood or a wad of paper between the teeth and 
holding it in place. 

No effort should be made to arouse the person from the period of 
unconsciousness which follows, but he should be warmly covered and 
placed in a safe place and allowed to sleep until he a weakens naturally. 

In examining unconscious persons in which a fit is suspected always 
look at the tongue and also the forehead and face. If the tongue is 
badly scarred, or if there are many old scars around the forehead, it 
is strongly presumptive that the person has epilepsy. In the un¬ 
consciousness following an epileptic attack the pulse is good, the 
breathing is regular, the face is slightly pale, and the pupils are 
equal. 

BRAIN INJURIES. 

Concussion .—By concussion is meant a shocking or jarring of the 
brain substances such as follows a blow on the head. 

Symptoms. —The symptoms are dizziness, nausea, and more or 
less loss of consciousness, depending upon the severity of the injury. 

Treatment. —Place the person in a recumbent position with the 
head slightly raised and allow him to react. Stimulate by placing a 
few drops of ammonia water on a handkerchief and every minute 
hold it under the nose until the patient has taken one breath. Too 
much ammonia is very irritating hence the patient should be given 
only an occasional whiff of the gas. When he can swallow adminis¬ 
ter one-half a teaspoonful of aromatic spirits of ammonia in a little 
water. If there is a wound of the scalp, treat as directed on page 199. 

Compression of the brain .—Compression of the brain may be due 
to a depressed fracture of the skull which ordinarily does not pro¬ 
duce unconsciousness, or to a hemorrhage into the brain substance or 
between the brain and the skull. The compression due to hemor¬ 
rhage is often characterized by unconsciousness coming on some time 
after the injury. 

Symptoms. —At first the pulse may be slow and very strong, later 
it becomes rapid and weak. The breathing is very slow and of a 
peculiar snoring type. The lips may puff out when the breath is 


290 


PREVENTION OF DISEASE AND CARE OF SICK. 


expelled. The face is red and the skin dry. The pupils of the eyes 
are not equal, but one of them will be considerably larger than the 
other (fig. 324). There is also paralysis on one side of the body. It 
is difficult to detect paralysis in an unconscious person, but it may 
be done by comparing the way in which the arms or legs fall when 
they are slightly lifted from the ground. 

APOPLEXY. 

Apoplexy, or a stroke as it is sometimes called, is due to the spon¬ 
taneous rupture of a blood vessel in the brain and the resulting 
hemorrhage into the brain substance. Apoplexy generally occurs 
in elderly individuals, especially those who are of the type known as 
full-blooded. Reference is often made to hardening of the arteries, 
which is a frequent cause of apoplexy. In certain persons the 
arteries lose their elasticity and actually become hard. The artery 
at the wrist may be felt through the skin, somewhat resembling a 
hard cord or a pipestem. When a general hardening of the arteries 
takes place throughout the body the blood pressure rises and the 
arteries are weaker than normal. The arteries in the brain are not 
supported by the surrounding tissues, hence rupture of a vessel is 
more apt to take place here than in other parts of the body. 

Symptoms. —These are practically the same as those of compres¬ 
sion. The patient suddenly or gradually becomes unconscious. The 
pulse is generally weak and rapid, but may at first be unusually slow 
and strong. The breathing is slow, the patient snores, and the lips 
and cheeks puff out at every expiration. The mouth is drawn to one 
side, and the patient, if he endeavors to talk, talks out of that side. 
The face is red and the skin warm. The pupils are unequal. If the 
patient is unconscious he can not be aroused. There is usually 
paralysis of one side of the body. 

Wounds of the brain .—Severe head injuries may be accompanied 
with actual wounds of the brain or escape of the brain substance. 

Symptoms. —These are varied, depending upon the location of 
the injury and the amount of damage done, but generally resemble 
either severe concussion, compression, or both. 

Treatment. —First-aid treatment of compression of the brain, brain 
injury, and apoplexy is the same. Raise the head on a pillow, give 
plenty of fresh air. Send immediately for medical help. Pending 
the arrival of the doctor cold cloths may be laid on the head, if there 
is no wound of that region. Bo not in any case give alcoholic stim¬ 
ulants. 

After treatment. —In the absence of a physician these conditions 
should be treated by placing the patient in bed, elevating the head on a 
pillow, and apply an ice bag or towels wrung out in cold water to the 
head, if there is no open wound. If there is a wound apply a sterile 


prevention of disease and care of sick. 291 

dressing first, and be careful that the cold applications do not wet the 
dressings. (See scalp wounds, p. 199.) Apply heat to the feet and 
legs. If the patient is conscious give a purgative and allow a very 
light liquid diet. (See also fractures of the skull, p. 255.) 

SUNSTROKE AND HEAT EXHAUSTION. ' 

Unconsciousness may be due to sunstroke or heat exhaustion. In 
sunstroke the face is red and the skin dry and hot. There is high 
fever and a strong pulse. In heat exhaustion the face is pale and 
the skin cold and clammy. There is no fever and the pulse is weak 
and rapid. 

For further symptoms and the treatment of these two conditions, 
see page 172. 

POISONING. 

GENERAL COMMENTS. 

The symptoms of poisoning depend upon what poison has been 
taken. Many poisons produce nausea, vomiting, purging, and 
collapse. Others bring on convulsions, or spasms, and a few cause 
the patient to become gradually unconscious without any other 
striking symptoms. 

In endeavoring to determine what poison has been taken, if no 
information can be obtained from the patient, an examination of the 
surroundings may throw light on the case. An empty bottle may be 
discovered in the vicinity or some of the substance may have been 
spilled over the floor or clothing which can be smelled and otherwise 
examined. It may be ascertained that certain poisons were in the 
house and one of these may show signs of having been recently 
opened or handled. Always smell the breath and examine the mouth. 
The mouth may be stained or burned by certain chemicals in a 
characteristic way, such as follows drinking carbolic acid or other 
strong acids. 

If the patient has taken a drug accidentally he will, of course, be 
willing to tell what it was, if he is conscious. 

A skilled physician is often able to decide from the symptoms what 
poison has been taken, but this can not be expected of a layman. 
Always send immediately for a doctor if poisoning is suspected, 
but pending his arrival certain first-aid measures may be undertaken. 

General treatment of all poisoning .—In the absence of a direct 
knowledge as to just what to do, the following line of procedure is 
recommended: 

First. Give the antidote if it is known and available. Lacking 
the proper antidote, white of eggs, milk, or strong tea may be admin¬ 
istered, as they will do no harm and are somewhat antagonistic to a 
number of common poisons. 


292 


PREVENTION OF DISEASE AND CARE OF SICK. 


Second. Get the poison out of the stomach as promptly as possible. 

After administering the antidote the stomach should be emptied as 
quickly as possible. The antidote is expected to combine with the 
poison and render it harmless, but it may not be effective, or the 
.resulting mixture may be harmful if afterwards absorbed. To cause 
vomiting, tickle the back of the throat with the forefinger or give an 
emetic. 

Emetics .—Emetics are substances which produce vomiting. The 
ones most available are luke-warm water mixed with mustard or 
common salt. A heaping teaspoonful of mustard or salt to a cupful 
of luke-warm water—stir it and have the patient drink the mixture. 
Repeat the dose every 10 minutes until 3 or 4 tumblerfuls have been 
swallowed if vomiting does not occur sooner. It is well to cause the 
patient to vomit several times and to have him drink freely of luke¬ 
warm water in the intervals. This process assists in washing out the 
stomach. One or two teaspoonfuls of sirup of ipecac or wine of 
ipecac are good emetics. Such preparations of ipecac are often 
kept in the home to administer to children with croup. 

There are a few poisons in which it is not wise to give an emetic, 
but in an emergency, in the absence of a doctor and specific knowl¬ 
edge to the contrary, the general rule for giving an emetic holds. 

Third. After giving the emetic and producing vomiting, the va¬ 
rious symptoms which arise should be treated according to the*nature 
of the case. 

If the pulse becomes rapid and weak, hot coffee, one-half teaspoon¬ 
ful of aromatic spirits of ammonia, or small doses of whisky or 
brandy should be given. If the patient is greatly weakened and 
prostrated, as he generally will be, hot-water bottles should be ap¬ 
plied around the feet and extremities and measures taken to sustain 
the general strength. 

Warning. —Poisons, such as carbolic acid or antiseptic tablets, 
should not be kept on the same shelf with harmless remedies. Such 
drugs should be kept in a separate place or in a special box and well 
out of the reach of children. Poisonous solutions should never be 
left in drinking glasses, as children or even adults may drink them 
without the knowledege of their dangerous character. 

SPECIAL POISONS. 

The treatment of a few of the commoner poisons will be described 
briefly. 

CARBOLIC ACID. 

Symptoms .—These come on very quickly. There is violent vomit¬ 
ing and purging, with pain in the stomach. The skin is drenched 
with sweat, the pulse is weak and rapid, and the patient goes into a 


PREVENTION OF DISEASE AND CARE OF SICK. 


293 


state of extreme prostration. The burnp produced in the mouth by 
the pure acid are white areas surrounded by red edges. The crude 
acid produces black marks on the lips arid in the mouth. The burns 
in the mouth and the odor of the drug will often enable one to decide 
what has been taken. 

Treatment .—Give a heaping tablespoonful of Epsom salts dissolved 
in water. Wash the mouth out with whisky, brandy, gin, or alcohol 
and water, equal parts. After the rinsing have the patient swallow 
three or four tablespoonfuls of any of the above liquors diluted in 
water (adult doses). Alcohol is not an antidote, but checks the caus¬ 
tic action of the acid. 

If the patient is not vomiting, give an emetic to free the stomach 
of what may be taken up by the alcohol. Put the person in bed. 
Give general stimulants, such as hot coffee, and apply external heat 
by hot-water bottles. 

BICHLORIDE OF MERCURY OR CORROSIVE SUBLIMATE. 

This substance is most used as a germicide and is frequently kept 
in houses for making solutions for washing wounds, etc. It is gen¬ 
erally made into tablets with some coloring matter, red or green, 
and these tablets are commonly called antiseptic tablets. Bichloride 
of mercury is an extremely powerful poison, and many deaths both 
accidental and suicidal have been recently reported from taking this 
substance. 

Symptoms .—A strong metallic taste in the mouth, intense pain in 
the stomach, with vomiting and free purging. Later extreme weak¬ 
ness and collapse. If the patient is tided over the acute symptoms, 
death may follow several days later from kidney failure. 

Treatment .—The antidote is raw white of egg, which should be 
immediately given. Use two or more eggs. If eggs are not at hand 
finely chopped lean raw meat mixed with water or milk may be ad¬ 
ministered. Strong tea is also useful. It has been suggested that a 
man alone in the woods who accidentally swallowed a bichloride 
tablet might open one of his own veins and suck his own blood, as 
the albumen of the blood will form an antidote. After giving any 
of the above, excite vomiting by emetics. The albumen of the egg 
or meat unites with the mercury but will afterwards be absorbed, 
hence it is necessary to remove it. Put the patient in bed. Give 
more white of egg, barley water or thin cooked starch and apply 
external heat by water bottles. Give stimulants, such as hot coffee, 
if necessary. 

Kecently a number of chemical antidotes, which it was believed 
would neutralize the poison which had been absorbed into the system 
have been proposed. None of these, however, have apparently stood 
the test of animal experimentation satisfactorily. 

49071 °— 23 - 24 



294 


PREVENTION' OF DISEASE AND CARE OF SICK. 


OPIUM, LAUDANUM. MORPHINE, AND HEROIN. 

These are all alike in their action and produce similar symptoms 
and are treated in the same way. 

Symptoms .—At first drowsiness, later followed by complete un¬ 
consciousness. The pulse is at first slow and strong, later weak and 
rapid. The respirations are very slow. The patient may breathe 
only six times a minute. The face is red and dusky. The skin is 
warm and the pupils are contracted (fig. 322). 

Treatment .—Give strong tea or permanganate of potassium, one- 
third of a teaspoonful dissolved in a pint of water. Then endeavor 
to induce vomiting by the finger in the throat or emetics. A cupful 
of very strong black coffee may be injected into the rectum by means 
of a fountain syringe. If conscious, give strong black coffee by the 
mouth. It is essential to keep the patient awake. This can be done 
by forcing him to walk supported by two assistants. Tickling in 
the ribs is also helpful, producing the same result. Inhalations of 
ammonia, strong coffee, 1/100 of a grain of atropine sulphate, or 
1/30 of a grain of strychnine sulphate will assist in maintaining the 
heart. It may be necessary to use forceful measures to keep the 
patient awake for a number of hours. As long as the patient is 
awake he will continue to breathe, but if he is permitted to sleep, 
breathing is apt to stop. If breathing fails, use artificial respiration. 

STRONG ACIDS, SUCH AS MURIATIC ACID, NITRIC ACID, OR 

SULPHURIC ACID. 

These acids are frequently used in shops and factories for various 
commercial purposes and they may be accidentally swallowed. 

Symptoms .—The mouth is burned by the acid, leaving brown or 
black stains. Similar marks are made if any of the substance is 
spilled on the clothing. The patient may go into collapse at once 
or in milder cases there is intense pain in the stomach, followed by 
vomiting and purging. 

Treatment .—Give no emetic. Give as an antidote large drinks of 
water with chalk, magnesia, or baking soda. Plaster from the wall 
may be given in an emergency. Olive oil, raw whites of eggs, and 
thin starch are useful. After treatment consists of rest in bed, ap¬ 
propriate stimulants, and external heat. 

LYE, AMMONIA WATER, OR OTHER STRONG ALKALIES. 

% 

Symptoms .—Intense pain in the stomach, nausea, and vomiting. 
Later followed in severe cases by collapse. 

Treatment .—Give diluted vinegar, lemon juice or orange juice, or 
whites of eggs in water. It is not wise to give an emetic and patient 
will generally vomit without. The irritant effects of the poison 


PREVENTION" OF DISEASE AND CARE OF SICK. 4 295 

should be overcome by administering olive oil, milk, barley water, or 
flaxseed tea. Puc the patient in bed and give general stimulants if 
needed. Keep up tfie body heat, applying hot-water bottles to the 
extremities. 

TINCTURE OF IODINE. 

Tincture of iodine is a common household remedy, but is poisonous 
internally and may be accidentally swallowed. 

Symptoms .—Pain in the throat and stomach, vomiting and purg¬ 
ing, the face is pale, and the pulse weak and rapid. 

Treatment .—Give boiled starch or flour paste or mashed potatoes 
as an antidote. Empty the stomach by emetics. Administer stimu¬ 
lants, such as hot coffee or one-half a teaspoonful of aromatic spirits 
of ammonia every hour. Apply external heat by hot-water bottles. 
Afterwards give soothing and mucilaginous drinks, such as flaxseed 
tea, barley water, or tapioca gruel. 

ARSENIC. 

The various salts of arsenic, such as Paris green and others, are 
frequently used in sprays for trees or vegetables, for preserving 
skins, as the active agent in fly papers, and sometimes as poison for 
small animals. 

Symptoms of arsenical poison .—These come on about an hour after 
the substance has been taken and resemble in many respects acute 
cholera morbus. There is pain in the abdomen and a feeling of con¬ 
striction in the throat, accompanied with severe vomiting and pro¬ 
fuse diarrhea. Later the stools are very thin, containing a few flakes 
of mucous and often streaked with blood. Finally great general 
weakness comes on, with shallow breathing and a very rapid and 
weak pulse. If the patient lives until the third day the symptoms 
may become very much milder at this time, only to be followed sub¬ 
sequently by a relapse, generally ending in death. 

First-aid treatment .—The chemical antidote is prepared by stirring 
a teaspoonful of magnesia into a cup of water, adding 2 tablespoon¬ 
fuls of tincture of iron, stirring well, and then giving the entire mix¬ 
ture as one dose. If magnesia is not available, ammonia water or 
aromatic spirits of ammonia may be added to any solutipn which 
contains iron, such as tincture of iron, the resulting precipitate col¬ 
lected by filtering it through several thicknesses of cloth placed in a 
funnel and then washing the precipitate by pouring clean water on 
the cloth until the smell of ammonia has disappeared. About 2 table¬ 
spoonfuls of this soft gelatinous mass should be mixed with water 
and administered by the mouth. The stomach should be emptied by 
emetics after the antidote has been given, or before if the antidote is 
not available. Magnesia alone is useful as an antidote in table¬ 
spoonful doses mixed with water. 


296 . PREVENTION OF DISEASE and care of sick. 

After administering the antidote and producing vomiting give 
soothing gruels, such as flaxseed tea, thin cooked starch, tapioca gruel, 
and later two tablespoonfuls of castor oil to empty the bowels. 

The general strength should be supported by artificial heat, plenty 
of bedcovers, and small doses of strong coflee. Pain in the stomach 
may be allayed by a hot-water bottle and doses of opiates, such as 
10 drops of tincture of opium or a sixth of a grain of morphine 
sulphate. 

STRYCHNINE. 

Strychnine is often used as a poison for wolves, squirrels, and 
small - animals and may, of course, also be kept in the house as a 
medicine. 

Symptoms of strychnine poisoning These come on either sud¬ 
denly or gradually. The patient, without warning, goes into con¬ 
vulsions or stiffness of the neck; a feeling of apprehension and 
muscular twitching may occur before the convulsions develop. The 
convulsions are very severe, and the body is often arched over back¬ 
ward like a bow, the patient resting only on the head and heels while 
attacked. The sufferer is conscious, greatly alarmed, and the corners 
of the mouth are drawn up, producing a sarcastic smile. 

First-aid treatment. —Give several cups of strong tea as the chemi¬ 
cal antidote and then excite vomiting by any of the previously 
mentioned emetics. After causing vomiting several times and wash¬ 
ing out the stomach as thoroughly as possible in this way, give 
40 grains of potassium bromide and 10 grains of chloral. This dose 
may be repeated at the end of two hours. If the convulsions pre¬ 
vent the administration of the medicine by mouth, it may be possible 
to give it by the rectum in the shape of a small injection. The 
patient should be kept in a dark room and very quiet, as any sort of 
stimulation may bring on the convulsions. Artificial respiration will 
sometimes be necessarv. 

PTOMAINE POISONING. 

Certain kinds of bacteria when they grow in some foods, especially 
fish, shellfish, and mixtures of eggs with cream or milk, produce 
highly poisonous compounds called ptomaines. The eating of such 
contaminated food is followed by ptomaine poisoning. The forma¬ 
tion of the ptomaines in food is favored by warm weather and long 
keeping. 

Symptoms. —Headache, pain in the muscles, nausea, thirst, intense 
pain in the stomach, vomiting, and purging. The patient rapidly 
grows very weak and in severe cases goes into collapse. The symp¬ 
toms may come on immediately after the food has been eaten or may 
not appear for some hours. 


PREVENTION' OF DISEASE AND CARE OF SICK. 


297 


Treatment. —If vomiting has not occurred, give an emetic. Also 
administer a rectal injection of a pint of soapsuds to quickly empty 
the bowel. Follow the emetic in half an hour with a large dose of 
castor oil. Keep the patient in bed, administer stimulants if neces¬ 
sary, such as small doses of strong coffee or a tablespoonful of whisky - 
every two hours. Surround the extremities with hot-water bottles. 
Keep the patient warm. 

Vomiting can be held in check by small drinks of plain soda 
water, ginger ale, or of iced champagne if available. No food should 
be allowed until the acute symptoms have subsided, and then only 
a liquid diet in small quantities at first. 

A characteristic feature of true ptomaine poisoning is that the 
patient remains weak for a long period and that recovery is very 
slow, oftentimes requiring several weeks. 

MUSHROOM POISONING. 

Certain varieties of mushrooms are highly poisonous, and if eaten 
produce severe illness and often death. There is no simple test for 
distinguishing the harmful kinds from the wholesome mushrooms, 
such as boiling them with a silver spoon, as is sometimes believed. 
To properly select the safe species of wild mushrooms from the 
poisonous ones requires a considerable knowledge of this subject, 
which can only be obtained by a careful study of textbooks. 

Symptoms .—The first effects of poisonous mushrooms appear in 
from 6 to 12 hours after they have been eaten. They are head¬ 
ache, nausea, vomiting, pain in the stomach, and purging. Later on 
there is great thirst, muscular twistings or convulsions, the pulse is 
rapid and weak, and the skin cold and clammy. The patient may 
become delirious or go into a stupor. 

Treatment .—The same as for ptomaine poisoning (p. 296). If 
atropine sulphate is at hand or can be obtained, give 1/100 of a 
grain every three hours until three doses have been taken. If the 
patient is vomiting, a hypodermic tablet of atropine can be placed 
under the tongue and it will be absorbed even if it is not swallowed. 

GENERAL DIRECTIONS FOR AIDING THE INJURED. 

In case of accident or sudden grave illness, humanity demands 
that those who happen to be present should take ail possible meas¬ 
ures for the relief of the afflicted person. It is entirely possible for 
any person of ordinary intelligence to master enough of the art 
of first aid so as to be able to give a great deal of valuable assist¬ 
ance pending the placing of the patient under regular medical care, 
and such help, if properly and promptly administered, may fre¬ 
quently in severe cases be the means of actually saving life. When 
a person is hurt or suddenlv becomes sick it is almost as important 


298 


PREVENTION OF DISEASE AND CARE OF SICK. 


to know what not to do as it is to know what to do, for ignorant 
volunteer assistants have often done their friends more harm than 
good by their ill-advised treatment. Knowledge of what is best 
to do in such emergencies can only be obtained by some training and 
the use of a great deal of common sense. It is therefore desirable 
that everyone should spend a moderate amount of time in studying 
at least one of the various manuals which have been prepared on 
this subject. 

GENERAL RULES AS TO WHAT TO DO IN CASE OF ACCIDENT. 

The conditions under which accidents happen vary so much that it 
is difficult to lay down rules which will be broad enough to cover 
all cases, but there are certain principles which should be followed in 
a general way when disasters of this sort occur. 

First. A rapid preliminary survey of the person should be made 
to determine what must be done, first of all, in any particular case. 

This preliminary examination should endeavor to ascertain whether 
the injuries can properly be classified as serious or trivial. If the • 
person is conscious, this information can be at once obtained upon 
inquiry. If unconscious, the nature of the accident will almost always 
decide as to the probable gravity of the case. 

Second. Note quickly the surroundings. 

This is for the purpose of deciding on how soon additional help 
can be obtained and whether the individual is in danger of further 
injury from the nature of the place in which he is. A person may 
be hurt by a falling building, or be found in a room filled with gas, 
and it may be likely that further injuries may be received from the 
same source unless he is immediately moved, or it may be perfectly 
proper to permit him to remain for the present where the accident 
occurred. 

Third. Now make a more careful examination of the patient to 
determine the location and nature of the injury. 

Frequently in case of accident a glance at the injured person will 
be sufficient to determine where and how he is hurt. One leg may be 
doubled up in an unnatural position, part of the clothing may be 
torn or marked, as by the black streak left by a car wheel, or blood 
may be appearing on some part of the body. It may be necessary to 
partially undo some of the clothing to ascertain more correctly the 
amount and source of bleeding. 

If the patient is unconscious, note the color of the face and the 
condition of the skin; take the pulse, examine the eyes, feel the head 
for a possible fracture of the skull, and observe the manner in which 
the patient is breathing, especially watching for puffing of the lips. 

Fourth. Determine the proper course of action under the condi¬ 
tions present. 


PREVENTION OF DISEASE AND CARE OF SICK. 299 

Having gotten some idea as to the nature and extent of the injuries, 
the amount of help available, and the general circumstances of the 
accident, all of which should not consume more than a minute or two, 
it is necessary to lay out and follow a definite plan of procedure, 
which will depend upon the data which has been obtained. If the 
person is bleeding very rapidly, that must be attended to without 
further delay. (See rules for checking hemorrhage, p. 204). If the 
loss of blood is not alarming, one can then proceed along the following 
lines: 

If a doctor is within easy reach it may not be necessary to do more 
than to send one of the bystanders for him and make the patient 
as comfortable as possible pending his arrival. In sending for the 
doctor it is always best to give him as complete a statement of the 
nature and extent of the injury as is practicable. Then the doctor 
will know what instruments and other materials to bring with him. 
If circumstances permit, this information may be given in writing. 
If plenty of help is at hand another messenger should be immediately 
detailed to inform some one in authority of the accident. In a city, 
this would be the foreman of the shop or the superintendent of the 
plant; on board ship, the captain; in the street, the nearest policeman 
or police headquarters should be notified. 

If the person is in a dangerous place or exposed to severe weather, 
it may be necessary to move him. If the danger is very imminent, 
this must be done at once, but all possible precautions should be 
taken to avoid increasing the damage already done, especially if there 
are any broken bones. In moving a person with a fracture the sharp 
ends of the bone may tear the flesh and even be driven out through 
the skin, creating a compound fracture, which is much more dan¬ 
gerous than a simple one. Having moved the patient, if absolutely 
necessary, or if it is decided to allow him to remain where he is 
pending the arrival of medical help, proceed to administer first aid, 
being guided by the following suggestions: 

1. PLACING THE INJURED PERSON IN A PROPER POSITION. 

Tight collars or belts should be loosened. The person should be 
kept in a recumbent or semirecumbent position. If the face is pale, 
lower the head and have the person lie horizontally. If the face is 
flushed the head may be raised on a folded coat, blanket, or other 
suitable material. If vomiting occurs, turn the head to one side so 
that the vomited matter will run out of the mouth and not flow 
down the windpipe, which may cause choking, and later, on inspira¬ 
tion, pneumonia. Do not attempt to force unconscious persons to 
drink water or stimulants, as they can not swalkw. 


PREVENTION OF DISEASE AND CARE OF SICK. 


300 


2. REMOVE CLOTHING CAREFULLY. 

In removing a coat or shirt to determine the amount of injury take 
the clothing off of the sound side first, and then it can be more easily 
removed from the affected part. This will avoid the danger of dis¬ 
turbing a fracture. It is sometimes advisable to cut the clothing off. 
In such a case cut along a seam or rip up a seam. Always cut the 
clothing when it is necessary to examine a badly injured or crushed 
limb. 

In removing the clothing have a due regard for the proprieties and 
do not expose the patient unnecessarily. 

3. TREAT THE MOST DANGEROUS CONDITION FIRST. 

Always check serious hemorrhage before doing anything else. 
Put some sort of a dressing on a compound fracture before applying 
splints. Treat shock before dressing extensive burns. Be prepared 
to improvise headrests, tourniquets, splints, dressings, and stretchers 
out of material available. 

4. PROTECT WOUNDS. 

All wounds should be covered promptly with some sterile material, 
or if that can not be obtained the wound should be exposed to the 
air and the clothing fastened back out of the way, so that it will not 
rub against the wound or all over it. 

5. BE ON THE LOOKOUT FOR SHOCK. 

In severe injuries always examine for shock and administer suit¬ 
able remedies if symptoms of shock are present. In this connection 
remember that keeping an injured person warm is of great impor¬ 
tance, even though he is not in shock. It is a general rule in first-aid 
work to keep the head cool and the feet warm. 

6. HANDLE THE CROWD. 

Always see that the patient has sufficient air. Keep the crowd back 
and do not permit the curious or overzealous to disturb the patient. 
Objectionable bystanders who are needlessly exciting the sufferer can 
often be gotten rid of by sending them on errands, even if the errand 
is unnecessary. 

7. ENCOURAGE THE PATIENT AS MUCH AS POSSIBLE. 

A cheerful and hopeful attitude on the part of the assistants or 
bystanders is always beneficial to an injured person. Don’t dwell on 
the accident or tell the patient how seriously he is hurt, but proceed 
quietly to do what is necessary without unnecessary consultation or 



Fig. 329.—Coat stretcher. 



Fig. 330.—Method of lifting patient with three assistants, step one. 



Fig. 331.—Lifting patient with three assistants, step two, 


























Fig. 332.—Carrying patient in chair. 


Fig. 335.—Patient lashed to stretcher. 




Fig. 333.—Carrying patient on chair with poles. 


Fig. 337.—Carrying patient; (Bearers 
grasping each other’s nearest shoulder 
and clasping their outside hands.) 































PREVENTION OF DISEASE AND CARE OF SICK. 


301 


discussion with the patient. If the person is conscious, however, in 
©very instance, ask him if he desires your assistance before undertak¬ 
ing to administer first aid. 

Sometimes witnesses of accidents hesitate to go to the assistance of 
an injured person because they become sick or nauseated at the sight 
of blood. This feeling can generally be overcome by keeping busy 
and having the mind occupied with relief measures rather than 
dwelling on the horrors of the accident. Standing idly by an injured 
person may make even an experienced surgeon feel squeamish, but 
the moment he starts to work the feeling disappears. 

In all cases of accident it seems hardly necessary to say that the 
one who is rendering assistance should absolutely retain his self- 
control and not give way to panic. Knowledge of what to do in such 
emergencies is of material aid in keeping one’s self-possession. Such 
information may be obtained by a careful study of any of the books 
on first aid now available. 

% . 

TRANSPORTATION OF THE INJURED. 

The best method of transporting an injured person is in a wagon 
or motor truck. The bottom of the vehicle can be padded with hay, 
straw, clothing, or similar material, and the patient laid on this or a 
mattress. It is imperative in fractures of the thigh or upper part of 
the leg that the patient be stretched out at full length; also that he 
be reclining if he has shock or other serious constitutional symptoms. 
The great number of automobiles and taxicabs in use and the speed 
and smoothness with which they travel makes them especially appli¬ 
cable for cases where the patient may be allowed to assume a sitting 
position, such as injuries to the upper extremities or the foot. Fre¬ 
quently such modes of transportation are unavailable and then re¬ 
source must be had to stretchers or litters. 

Stretchers are appliances for moving the sick or injured and are 
borne by two or more persons. The essential parts of a stretcher are 
two stout poles about 8 feet long with a strip of some strong material 
fastened between on which the person lies. The ends of the poles act 
as handles. Regular stretchers (fig. 326) are the most convenient, 
but in an emergency similar appliances may be easily constructed in 
a number of ways. A very serviceable litter may be devised out of 
two gunny sacks and two suitable poles. Two holes are made in the 
bottom of the sacks at opposite comers. The poles are placed inside 
the bags, thrust through the holes, and the sacks drawn into place. 
Cross strips of wood may be lashed or nailed between the poles to 
hold them apart (fig. 327). 

Another method is to lay a blanket on the ground and roll the 
outside edges around the poles and to continue the rolling until the 


SO2 PREVENTION OF DISEASE AND CARE OF SICK. 

poles are about 20 inches apart. The blankets are then fastened by 
nailing them to the poles or tying securely with strips of strong 
twine (fig. 328). Canvas may be used in place of a blanket. 

A coat stretcher is constructed out of two coats and two side poles. 
The coat sleeves are first turned inside out. The poles are thrust 
through the sleeves from the shoulder and the coats buttoned around 
the poles with the buttons down, making a webbing across (fig. 329). 

If tools and lumber are available, an excellent stretcher may be 
constructed out of boards. Make the bed about 6 feet long and 18 
to 20 inches wide. Suitable handles can be fastened to the ends or 
sides. Injured persons can be also carried on doors, shutters, benches, 
a short length of ladder, etc., but all rigid appliances of this sort 
must be padded with blankets, clothing, mats of straw, or some 
cushioning material. 

Every improvised stretcher should be tested by placing a well man 
on it before it is used for an injured person. 

A great many instructions have been written about the methods 
to be used in lifting a patient onto a stretcher. These are very useful 
for military forces and other trained bodies, but they are somewhat 
elaborate and likely to be forgotten in an emergency by the ordinary 
person. It is best, therefore, to depend largely on common sense, 
being especially careful to see that no additional harm is inflicted on 
the injured part. 

Ordinarily place the stretcher alongside of the patient, who is on 
his back on the ground. If plenty of help is available, have one per¬ 
son raise the head and shoulders, another the hips, and a,, third the 
knees (figs. 330 and 331). These helpers stand or kneel on one side of 
the patient, with the stretcher on the other side. A fourth assistant 
stands on the opposite side, and his whole duty is to reach over the 
stretcher and handle and support the injured arm or leg. 

If but two persons are present the head and shoulders may be 
lifted on the stretcher first. The helpers then change their position 
to the lower part of the body and lift the hips and legs onto the 
stretcher, guarding the injured part as carefully as possible. 

When the patient is on the stretcher he should be well covered with 
blankets or clothing. Ordinarily the bearers can well dispense with 
their coats for this purpose. It makes no material difference whether 
he is carried feet or head forward except in going uphill or upstairs, 
when the head should always go first. The bearers should break 
step and proceed slowly. The stretcher handles should be supported 
by the arms hanging down and should not be borne on the shoulders. 
If obstacles are encountered it is best to try to go around them. If 
it is necessary to lift a stretcher over a fence, the leading bearers rest 



Fig. 338.—Carriage by arms and knees. 


Fig. 339.—Carrying in arms. 




Fig. 340.—Lifting partially unconscious person (1). 


Fig. 341.—Lifting partially unconscious 
person (2). 


* 






















Fig. 342.—Lifting partially unconscious 
person (3>. 


Fig. 343 —Lifting partially unconscious 
person (4). 



Fig. 344.—Lifting partially unconscious person (5j. 


Fig. 345.—Lifting partially uncon¬ 
scious person (6).' 


r tsar* 

iH 































PREVENTION OF DISEASE AND CARE OF SICK. 303 

their handles on it first, the rear being supported by the others. Then 
the leaders cross the fence, and the stretcher is moved forward so that 
the rear end rests on the fence and the front is supported by the 
leaders. The rear men now go over and take their former positions. 

It is impossible to handle a stretcher in trenches, narrow halls, 
ship’s hold, or similar places. Under such circumstances the patient 
may be carried in a chair (fig. 332). Two poles or rifles may be lashed 
between the legs of the chair and used as handles (fig. 333). They 
are attached in such a way that the chair tips well backward when the 
handles are level. The poles should be sufficiently long to afford 
space for the bearers to walk without coming in contact with the 
patient. 

A sl;ng may be constructed by taking two blankets and rolling each 

of them up diagonally from one corner, making a large cylinder. The 

two rolls are then united bv 

«/ 

tying them together at the ends. 

The loops thus formed are 
slipped over the heads of the 
two bearers and allowed to rest 
on their shoulders, the middle 
parts of the blankets forming 
two slings. The patient sits on 
the sligs and steadies himself by 
placing his arms around the 
necks of the bearers. 

Other devices for carrying 
men up ladders or hoisting them 
perpendicularly on stretchers are 
used in mines and on board naval 
vessels. 

Occasions may arise when it 
is impossible to take sufficient 
time to obtain a stretcher or 
other appliance for carrying an injured person, as for example in 
a burning building, or a room filled with gas, or on the battle field, 
when an engagement is in progress. Under such circumstances it 
is necessary for the helpers to carry the patient without the assist¬ 
ance of any apparatus. If there are two bearers a man may be car¬ 
ried for a short distance on what is known as the “ lady’s chair.” 
This is formed by each bearer grasping his left wrist with his 
right hand. The free left hand then grasps the right wrist of the 
other assistant (fig. 336). The injured person sits on the support 
thus formed and places his arms around the necks of the operators. 
Another method is for the bearers to stand side by side and each 
grasps the other’s nearest shoulder. The outside hands are clasped 



Fig.. 334.—Method of fastening poles to a 
chair in which bearers are on each side of 
patient. 



































304 


PREVENTION OF DISEASE AND CARE OF SICK. 


together, and the patient sits upon these. The other arms act as a 
backrest (fig. 337). An unconscious man may be carried for a short 

distance by the forward bearer stand¬ 
ing between the legs and seizing the 
knees, and the rear bearer support¬ 
ing the shoulders by putting his hands 
in the patient’s armpits (fig. 338). 

It is extremely difficult for one per¬ 
son to carry a patient for a consider¬ 
able distance. If the patient is con¬ 
scious, he may be carried on the back 
with his arms around the neck of the 
bearer and his thighs supported by the 
bearer's forearms in the manner known 
to children as “ piggy-back.” The 
greatest difficulty, however, comes 
when a single bearer attempts to pick 
up an unconscious person. It is, of 
course, practicable to lift a child or a 
very small adult in the arms (fig. 339), 
but with a heavy individual this is impossible for a man of ordi¬ 
nary strength. 

METHODS OF CARRYING AN UNCONSCIOUS PERSON BY ONE 

OPERATOR. 

Various methods are described for getting unconscious persons 
onto the bearer's back in order to transport them. An unconscious 
individual, however, is as limp as a wet towel, and, although he may 
be lifted to his knees without great difficulty, he is apt to fall forward 
on the face as soon as the bearer’s grip is shifted below the hips. 

If the patient is only partially unconscious and capable of stiffening 
himself a little, he may be gotten on the bearer’s back by the follow¬ 
ing maneuvers: 

First, turn the patient on his face. Stand astride of the body at 
the hips. Place the hands under the patient’s armpits and raise him 
to the knees (fig. 341). Work the hands downward along the chest 
until they reach the abdomen and then lift him to his feet. Holding 
him in this position with the right arm, grasp his left wrist with your 
left hand, lower your head, and pull his left arm around your neck 
(fig. 343). Now work the right foot forward in front of his legs, 
bending forward so that the body is supported on your back. Now 
put your right hand in front and pass it between the unconscious 
person’s legs, grasping his right thigh above the knee from behind 
(fig. 344). With a sudden motion throw the patient onto your own 










PREVENTION OF DISEASE AND CARE OF SICK. 


305 


back. Shift him further onto the back, release his left wrist, and 
grasp his right wrist with your left hand (fig. 345). The unconscious 
person is now on the back of the helper and can be carried without 
great difficulty. 

The maneuver of getting the patient on the back is a difficult one, 
and should be frequently practiced with a person who has made him¬ 
self limp for the purpose. It is well to begin on a half grown-up 
boy in order to acquire skill before attempting to practice it on an 

adult. 

49671 °— 23 - 25 





APPENDIX A. 


LIST OF REMEDIES MENTIONED IN THIS BOOK AND 

THEIR USES. 

Doses. —Unless otherwise stated, the doses mentioned in this book are in¬ 
tended for adults. To determine the dose for children, add 12 to the age of 
the child and divide the age of the child by this sum. This fraction will repre¬ 
sent the size of dose compared with that for an adult. For example, a child 6 

ft ft 

years old will require ^ or one-third of the adult dose. 

6+12 16 

Caution. —Preparations containing opium, such as laudanum, paregoric, cam¬ 
phor and opium pills, Sun Cholera Mixture tablets, etc., should not be used 
except where absolutely necessary, as their continued use is liable to produce 
the drug habit. 

Alcohol. —Externally, is useful as a mild antiseptic wash for 
wounds. As a liniment, pure or diluted with from 1 to 3 parts of 
water, is cooling and stimulating. 

Argyrol. —Useful, in 10 to 20 per cent solutions, as drops, for sore 
eyes, also as injection for gonorrhea. 

Aromatic spirit of ammonia. —Useful in hysteria, faintness, head¬ 
ache, flatulent colic, nervous debility, and as a stimulant in shock. 
Dose: J to 1 teaspoonful in water every half hour until three doses 
are taken. 

Aspirin ( 5-grain tablets). —Useful in rheumatism, neuralgia, 
cramps in stomach, colic, and headache. Dose: 1 to 2 tablets with 
hot water or tea every three hours. 

Belladonna plaster. —Useful in coughs, colds, rheumatism in joints 
and arms, lumbago, and pains in small of back. Should be worn 
only long enough to have the desired effect. If the throat becomes 
dr} r or the pupils dilated, indicating belladonna poisoning, the plaster 
should be removed. 

Bicarbonate of soda {baking soda). —Internally, useful in sour 
stomach and heartburn. Dose: 4 to 1 teaspoonful in half tumbler 
of water. Repeat in half an hour if necessary. 

Bismuth subnitrate (5-grain tablets). —Useful in dysentery, diar¬ 
rhea, and heartburn. Dose: 2 to 4 tablets every three hours. (Crush 
before taking.) 

Borax. —Useful in sore mouth. One tablespoonful dissolved in a 
pint of water and used as a mouth wash several times a day. 

307 




308 PREVENTION OF DISEASE AND CARE OF SICK. 

Boric acid ( boracic acid). —One-half teaspoonful may be dissolved 
in a glass of water and used as a lotion for the eyes and ears. 

Bromide of potash (5-gram tablets). —Useful in convulsions and 
delirium tremens. Dose: 3 to 5 tablets, dissolved in water, three 
times a day. 

Brown mixture lozenges. —Useful in bronchitis, coughs, and colds. 
Dose: 1 lozenge allowed to dissolve slowly in mouth; to be repeated 
as required. 

Calomel (Co-grain tablets). —Useful in constipation and dysentery. 
Dose for adults and children: Take 2 tablets every 15 minutes until 
20 tablets are taken. When from 4 to 6 hours have elapsed a Seidlitz 
powder or a dose of Rochelle or Epsom salt should be taken. The 
dose of the Seidlitz powder or salt should be proportionate to the 
age of the patient. 

Camphor and opium pills (poison). —Useful in relieving pain in 
diarrhea and dysentery. Dose: 1 pill every three hours until 4 are 
taken. 

Camphorated oil (for external use only). —In sprains, bruises, 
neuralgia, rheumatism, and pains and swellings of the breasts or 
joints it should be gently rubbed on the painful part. Applied on 
hot flannel to chest and neck for colds. 

Carbolic acid , liquid (poison). —Useful as an antiseptic and dis¬ 
infectant when mixed in the proportion of 1 part of acid to 100 parts 
of hot water. Useful without dilution to arrest the development of 
boils and carbuncles and as an application to ulcers and venereal 
sores. Should be applied cautiously. The surface should be merely 
touched with a small piece of cotton moistened with a drop of the 
acid, care being taken not to burn the surrounding skin. Do not 
use internally. 

Castor oil. —Useful in constipation. Dose: 1 to 2 tablespoonfuls. 

Chlorate of potash (5-grain tablets). —Useful in sore throat and 
sores in mouth. Directions: Dissolve 5 or 6 tablets in a wineglass 
of water and use as a gargle or mouth wash. 

Compound cathartic pills , vegetable. —Useful in constipation. 
Dose: 1 to 3 pills at night. 

Compound solution of cresol. —Useful as an antiseptic and disin¬ 
fectant when mixed with water in from 1 to 3 per cent solutions. 
(See pp. 104 and 188.) Do not use internally. 

Cough mixture—Mistura pectoralis (expectorans) N. F. —Stimu¬ 
lating expectorant. Useful in coughs and colds. Dose for an adult: 
\ to 1 teaspoonful. 

Cream of tartar. —In small doses (1 to 2 teaspoonfuls in sweetened 
water) acts as a cooling aperient, gently opening bowels. In large 
doses (1 to 2 tablespoonfuls) is a hydrogogue cathartic, causing free, 
watery stools. 


PREVENTION OF DISEASE AND CARE OF SICK. 


309 


Epsom salt .—Useful in constipation and dysentery. Dose: 1 to 2 
tablespoonfuls dissolved in as little water as possible. A little lemon 
juice and sugar may be added to disguise somewhat its bitter taste. 

Essence of peppermint .—Useful in cramps, colds, gas in stomach, 
and colic. Dose: 10 drops to ^ teaspoonful in sweetened water or on 
sugar. Externally is useful in rheumatism, neuralgia, and toothache. 

Flaxseed meal .—Useful as hot poultice to apply to boils and felons. 
Compresses, wet with hot bichloride solution, *1 tablet to 5 pints of 
hot water, are better. To prepare flaxseed poultice a receptacle con¬ 
taining boiling water should be placed on the fire, the flaxseed meal 
should be gradually added and constantly stirred until the batter is 
jellylike. This should be evenly spread, with a thickness of from \ 
to inch, to within 2 or 3 inches of the border of a cloth prepared 
for that purpose by folding in two or three layers. To prevent the 
poultice from adhering to the skin any of the following may be 
placed on its surface : Gauze, mosquito netting, cheesecloth, vaseline, 
or sweet oil. 

Formalin {poison ).—Used as a disinfectant generally in connec¬ 
tion with permanganate of potash, as follows: For every 1,000 cubic 
feet of room space to be disinfected use | pound of permanganate of 
potash, powder or crystals, and from 1 to 1J pints of formalin. Add 
the permanganate of potash to the formalin contained in a deep tin 
pail. Effervescence begins at once, the room is tightly closed, and 
the operation is over in about 10 minutes. After 12 hours the room 
is opened and aired. 

Glycerin .—Is a mild and healing application for sores, chaps, etc. 
When mixed with an equal quantity of water is useful in earache, 
hard, irritated, or feverish skin, chapped face or hands, split lips, 
and chafing. 

Iodide of potajsh {5-grain tablets ).—Useful in syphilis. Dose: 1 
tablet dissolved in water three times a day after meals. 

Laudanum {poison ).—Useful in easing pain in dysentery, cholera 
morbus, and in severe attacks of colic. Dose: 5 to 30 drops. To be 
used with great caution and only for acute emergencies. 

Lemon juice .—Useful in fevers and inflammatory complaints. Hot 
lemonade on retiring is useful to aid in the relief of a cold in its first 
stages. 

Lime water .—Internally is useful in soothing sick stomach, heart¬ 
burn, diarrhea, and in dyspepsia attended with acidity of the stom¬ 
ach. Dose: 1 to 3 tablespoonfuls. For sick stomach, to be repeated 
after each effort to vomit. Externally, as a liniment (mixed with an 
equal quantity of linseed, cottonseed, or olive oil) for burns and 
scalds. 

Magnesia ,, calcined , heavy .—Useful in sick headache, dyspepsia, 
sour stomach, and heartburn. Dose: ■£ to 1 teaspoonful 1 hour after 


310 


PREVENTION OF DISEASE AND OARE OF SICK. 


meals, and, being mildly laxative, for constipation in doses of £ to 1 
teaspoonful. 

Menthol. —Useful in oily solutions (menthol 3 grains, liquid petro¬ 
latum 1 ounce) as cooling drops in nose in colds in the head. Ten 
drops should be placed in each nostril with a medicine dropper. 

Mustard. —Externally is useful to draw the blood to the surface 
in case of pain where skin is not broken. Should be employed as a 
plaster or poultice, made as follows: 1 part of mustard is thoroughly 
mixed with from 2 to 4 parts of flour and made into a paste by the 
addition of a small amount of tepid water. This is then spread thinly 
to within 1 or 2 inches of the border of a cloth prepared by folding 
in two or three layers of old cotton cloth. The amount of mustard 
depends upon the degree of pain, the age of the patient, etc. Care 
should be taken that the mustard does not blister the skin. As a 
rule, mustard plasters or poultices should not be applied to children 
and old people, as they may blister the surface. Internally given 
to produce vomiting, 1 tablespoonful stirred to a cream with a cupful 
of tepid water. 

Oil of cloves (poison ).—Useful in toothache, being applied the 
same as creosote. (See above.) 

Olive oil (sweet oil). —Internally is useful in constipation. Dose: 
2 to 3 tablespoonfuls. Externally is a soothing application to blis¬ 
tered, burned, scalded, or other injured surfaces, also to piles. 

Oil of wmtergreen ( methyl salicylate). —Useful, when mixed with 
an equal amount of olive oil, as an application for the.relief of 
neuralgia, rheumatism, and painful joints. The oil should be gently 
rubbed on the painful area. If used about the head care should be 
taken that none gets into the eyes. 

Paregoric {poison). —Useful in quieting cough and relieving pain 
in the stomach and bowels and to check diarrhea. Dose: 1 to 2 tea¬ 
spoonfuls. To be used only in acute emergencies. 

Permanganate of potash. —Useful in gonorrhea as an injection: 
\ teaspoonful dissolved in 2 quarts of water. One teaspoonful to a 
quart of water makes an efficient wash for perspiring feet. Useful 
in snake-bites in the form of a concentrated solution which should be 
injected freely and immediately into and around the part which 
has been bitten. Useful as a general antiseptic in solution (1 table¬ 
spoonful dissolved in a quart of water). As a disinfectant, see 
“ Formalin/ 1 

Peroxide of hydrogen solution. —Is cleansing and slightly anti¬ 
septic. Useful as a gargle in sore throat, diluted with an equal quan¬ 
tity of water. Useful to apply to wounds, boils, and abscesses, after 
diluting with from 1 to 3 parts of water. 

Picric acid ( poison) dissolve in water (£ per cent solution ).—- 
Useful to wet dressings with, as an application to burns. 


PREVENTION OF DISEASE AND CARE OF SICK. 


311 


Quinine sulphate {5-gram tablets). —Useful in malaria, colds, and 
as a general bitter tonic. Dose: 1 tablet three times daily. Dose as 
tonic: J of a tablet three times a day. 

Salicylate of soda {5-gram tablets). —Useful in rheumatism, neu¬ 
ralgia, and headache. Dose: 1 to 2 tablets every three hours. 

Salol {5-grain tablets). —Useful in diarrhea, dysentery, rheuma¬ 
tism, and fermentative dyspepsia. Dose: 1 tablet three times a day. 

Sirup of ipecac. —Useful in croup, bronchitis, cough, and hiccough. 
Dose: 10 drops every three hours. Also used to produce vomiting in 
doses of 1 to 2 tablespoonfuls. 

Soap liniment {for external use only). —Useful in certain forms of 
rheumatism, sprains, and bruises. 

Spirit of camphor. —Internally is useful in nervous diarrhea, colic, 
and cramps. Dose: 5 to 30 drops, first added to sugar and then mixed 
with water. 

Sweet spirit of niter .—Useful in fevers, flatulent colic, and colds. 
Dose: \ teaspoonful in sweetened water every four hours. 

Tincture of green soap. —Cleansing hands. 

Tincture of iodine {poison) {for external use only). —Useful to 
disinfect wounds; should be diluted with an equal quantity of alcohol 
or water. If painted over inflamed surfaces, will sometimes be of 
value. 

Tincture of iron. —Useful as a tonic. Dose: 10 drops largely di¬ 
luted with water, three times a day. Rinse mouth after taking. 
Should be taken through a straw. 

Tincture of myrrh. —Useful in diseased gums and sore throat. Di¬ 
rections: For spongy and bleeding gums, apply with a sponge or 
soft brush. For sore throat, use as a gargle, 1 teaspoonful in cup¬ 
ful of water. 

Turpentine. —Used in the form of hot turpentine stupes in typhoid 
fever, pneumonia, colds, bronchitis, lumbago, pleurisy, and inflamma¬ 
tion of the bowels. The stupes are prepared by wringing a double 
layer of thin flannel out of a pint of hot water with which a tea¬ 
spoonful of turpentine has been mixed. These applications should 
not be prepared too close to a fire on account of the inflammability 
of the turpentine. 

Vaseline. —Internally and externally useful for the relief of cold 
in the chest. Externally useful in cold in the head, soothing irritated 
surfaces, burns, and scalds, and as a protective dressing. 

Zinc sulphate {poison). —Useful in gonorrhea as an injection, made 
in the proportion of £ teaspoonful to 1 pint of water. Is given in¬ 
ternally in doses of £ to £ teaspoonful dissolved in water to produce 
vomiting. 


312 


PREVENTION OF DISEASE AND CARE OF SICK 


LIST OF MEDICAL AND SURGICAL SUPPLIES FOR MEDICINE 

CHESTS. 

Medical supplies. 


For vessels. 

For homes 
and factories. 

Item. 

1 pound. 

1 pound. 

Absorbent cotton. 

1 pint. 

h pint. 

Alcohol. 

2 ounces. 

2 ounces. 

Areyrol, 10 per cent solution. 

* pint. 

4 ounces. 

Aromatic spirit of ammonia. 

Aspirin, 5-grain tablets. 

ido. 

100. 

1 yard. 

1 yard. 

Belladonna plaster (1 year). 

4 ounces. 

4 ounces. 

Bicarbonate of soda (baking soda). 

Bismuth subnitrate, 5-grain tablets. 

Borax. 

100. 

100. 

\pound. 

4 ounces. 

1 pound. 

i pound. 

Boric acid (boracicacid). powdered. 

100. 

100. 

Bromide of potash, 5-grain tablets. 

100. 

100. 

Brown Mixture lozenees. 

100. 

100. 

Calomel and soda tablets, each fa grain of calomel and fa grain of bicar¬ 
bonate of soda; amber-colored bottle (1 year). 

- 


Calomel and soda tablets, each h gram of calomel and 1 grain of bicar¬ 
bonate of soda; amber-colored bottle (1 year). 

} pint. 

4 ounces. 

Camphorated oil. 

I pint. 

i pint. 

(Poison.) Carbolic acid, liquid, pure. 

1 pint. 

1 pint. 

Castor oil. 

100. 

100. 

Chlorate of potash, 5-grain tablets. 

Compound Cathartic Pills, vegetable. 

100. 

100. 

1 pint. 

1 pint. 

Cough mixture, Mixtura pectoralis (expectorans) N. F. 

1 pint. 

1 pint. 

(Poison.) Compound solution of cresol. 

1 ounce. 

1 ounce. 

Eardrops, formula: Carbolic acid, 1 fluid dram; glycerin, 7 fluid drams; 
well mixed. 

2 pounds. 

1 pound. 

Epsom salt. 

4 ounces. 

2 ounces. 

Essence of peppermint. 

Flaxseed meal (linseed meal). 

1 pound. 

i pound. 

1 pint. 

1 pint. 

(Poison.) Formalin (1 year). 

1 pint. 

£ pint. 

Glycerin. 

100. 

100. 

Iodide of potash, 5-grain tablets. 

4 ounces. 

2 ounces. 

(Poison.) Laudanum (1 year). 

i pound. 

4 ounces. 

Magnesia, calcined, heavy. 

2 ounces. 

2 ounces. 

Menthol solution; Menthol, 3 grains; liquid, petrolatum, 1 ounce. 
Mustard. 

$ pound. 

4 ounces. 

1 ounce. 

J ounce. 

(Poison.) Oil cloves. 

Olive oil (sweet oil). 

1 pint. 

I pint. 

i pint. 

i pint. 

(Poison.) Oil of wintergreen (methyl salicylate). 

i pint. 

4 ounces. 

(Poison.) Paregoric. 

100. 

100. 

Permanganate of potash, 5-grain tablets. 

1 pint. 

1 pint. 

Peroxide of hydrogen solution (1 year). 

1 pint. 

i pint. 

(Poison.) Picric acid, \ per cent solution. 

100. 

100. 

Quinine sulphate, 5-grain tablets. 

100. 

100. 

Salicylate of soda, 5-grain tablets. 

100. 

100. 

Salol, 5-grain tablets. 

Sirup of ipecac. 

i pint. 

4 ounces. 

1 quart. 

1 pint. 

Soap liniment. 

1 pint. 

4 ounces. 

Sweet spirit of niter, dark-colored bottle (1 year). 

1 pint. 

i pint. 

Tincture of green soap. 

i pint. 

4 ounces. 

(Poison.) Tincture of iodine (1 year). 

% pint. 

4 ounces. 

Tincture of iron. 

i pint. 

4 ounces. 

Tincture of myrrh. 

1 pint. 

i pint. 

Turpentine. 

1 pound. 

1 pound. 

Vaseline. 


These medicines will remain serviceable until used if kept in glass- 
v stoppered bottles, with the exception of those marked “ 1 year,” 
which should be renewed after that interval. The containers of all 
articles marked “ 1 year ” should be plainly marked with the date on 
which such articles are received. 

For bulky articles not over a pint of each need be kept in the medi¬ 
cine chest.' 

Special bottles with a rough surface must be used for poisonous 
medicines. These bottles must be plainly marked POISON. 













































































































PREVENTION OF DISEASE AND CARE OF SICK. 


313 


Surgical supplies, etc. 


For vessels. 


For homes 
and factories. 


Item. 


2. 

2 dozen 

1. 

1 dozen. 
1 dozen 
1 dozen 
4. 

6 . 

1. 

6. 

1. 

1. 

1. 


1 


1. 

« . 

10 yards 
10 yards 

1. 

6 . 

1. 

2. 

2 dozen. 
1. 

1. 

« . 

1. 

2 . 

1. 

1. 

1. 

4 pieces. 

4 sheets 


1. 

1 dozen 

1. 

1 dozen 
1 dozen 

1 dozen 

2 . 

6. 

1. 

3. 

1. 

1. 

1. 


1 


1 . 

6 . 

5 yards. 

5 yards. 

1 . 

6 . 

1 . 

2. 

2 dozen. 

1 . 

1. 

3 . 

1. 

2. 

1 . 

1. 

1 . 

2 pieces. 

2 sheets 


Adhesive plaster, 10-yard reel, 1 inch wide. 

Applicators, small, wooden. 

Atomizers. 

Bandages, 2-inch by 3-yard (i dozen gauze and § dozen muslin). 

Bandages, 2-inch by 5-yard (| dozen gauze and f dozen muslin). 

Bandages (4-inch by 5-yard (muslin). 

Bandages, plaster of Paris, 3-inch. Each contained in an air and mois¬ 
ture proof container. 

Bandages, triangular (Esmarch’s bandage), with figures printed on 
them showing the various ways they can be used. 

Bistoury. 

Camel’s-hair brushes. 

Catheter, rubber, No. 20 F. (1 year). 

Corkscrew. 

Forceps, artery (hemostatic forceps). This can be used to grasp a 
bleeding vessel until it can be tied, or until the doctor arrives. A 
catch holds the grip of the forceps. Sterilize by boiling. 

Forceps, dressing or dissecting. Will be found convenient in cleaning 
up a wound and applying dressings; also in removing splinters, etc. 
Sterilize by boiling. 

Fountain syringe, 2-quart (1 year). 

Urethral syringes, glass. 

Gauze, picric acid. Good dressing for wounds and scalds. 

Gauze, plain, sterile. 

Hot-water bottle; rubber, 2-quart (1 year). Metal bottle preferred. 

Medicine droppers. 

Medicine glass. 

Nail brushes. 

Safety pins, large. 

Scissors, dressing, surgeon’s, for cutting gauze and bandages. Sterilize 
by boiling. 

Shears, for cutting cotton and muslin, etc. 

Splints ? wooden. Straight and angular splints made of thin board, a* 
described in chapter on “ Fractures.” 

Spool of silk ligature, medium size. 

Surgical needles, in glass-stoppered bottles. 

Thermometer, clinical, Fahrenheit. 

Tooth forceps, incisor. 

Tooth forceps, molar. 

Wire gauze, made of heavy mesh malleable wire. When well padded 
can be wrapped around a fracture for temporary dressing. 

Yucca palm (a thin fiber board). Can be wrapped around a fracture for 
temporary dressing. 


Gauze and bandages should be in paraffin-paper packages, sealed 
after sterilization. 

Catheters and other rubber goods should be in sealed paraffin pack¬ 
ages or envelopes, slightly dusted with sterile talcum 'on the inside 
of the package. 

Scissors and instruments, if not in cases, may be coated with par¬ 
affin, which will come off when dipped in hot water. 

Articles marked “ 1 year ” should be discarded after that interval 
and new ones obtained. The containers of all articles marked “ 1 
year ” should be plainly marked with the date on which such articles 
are received. 















































































APPENDIX B. 


Note 1 (p. 41). —In sand or loam and in selected locations where 
there is no danger of contamination of the water supply, the pit 
privy has a claim for consideration. The earth pit should be deep, 
large, fly-proof, ventilated, and curbed to prevent caving. Rain 
and other surface drainage should be carefully excluded, the pit 
kept dry, and earth sprinkled on the excreta. At intervals the 
privy should be moved, the old pit being carefully filled with earth, 
well mounded; and refilled after settling. 

Note 2 (p. 74).—Water is an essential element in the diet, both 
on its own account and because it frequently carries and supplies 
needed minerals, of which iodine is the most important. In certain 
regions where the water does not contain this element, goiter occurs 
frequently; and where there is this danger, doses of from two to 
three grains of sodium iodide should be given in water three times 
a day for a period of two weeks. The treatment, to be repeated 
every six months, is reported to be very effective in the prevention 
of endemic goiter. Persons who have already developed- exophthal¬ 
mic (not endemic) goiter should not take this treatment except on 
the advice of a physician. 

Note 3 (p. 147). —Scurvy is caused by a long-continued diet con¬ 
sisting of articles of food deficient in a special substance known 
as vitamine C. This vitamine is found in fresh milk, in the juice 
of fresh fruits, and in most edible vegetables. It is destroyed when 
exposed to a relatively moderate degree of heat. For this reason, 
infants and young children are liable to develop scurvy when fed 
for a prolonged period on patent foods, condensed milk, and steri¬ 
lized milk, which are usually exposed to high temperatures in their 
preparation. Such a diet should be supplemented by the addition 
of fresh orange juice, strained tomato juice, or other articles of 
food rich in vitamine C. 

314 



INDEX 


Page. 


Abrasions___..._197 

Abscess_, 176 

Accumulation of wax in ears_180 

Acute alcoholism_ 287 

Acute nephritis_170 

Acute rheumatism (rheumatic fever)_116 

Alcohol as a food_ 78 

Alcohol as a medicine_ 78 

Alcohol as a stimulant_ 78 

Alcoholic liquor_77 

Alkali poisons, antidote for_234 

Apoplexy_290 

Appendicitis_ 169 

Applying splints_248 

Arsenic, antidote for_295 

Arterial hemorrhage_208 

Artesian wells_ 35 

Artificial illumination_ 21 

Artificial respiration_276 

Bandages and bandaging_222 

Baths_ 81 

Bath, infants_ 97 

Bedbugs_ 60 

Bee sting_202 

Beef tapeworm (Taenia saginata)_148 

Beriberi_ a_146 

Bichloride of mercury or corrosive sub¬ 
limate poisoning_293 

Bites of cats and other small animals— 204 
Bites and stings of poisonous animals 

or insects_200 

Black eye_233 

Bleaching powder for purifying water. 32 

Bleeding_204 

Bleeding from special parts_216 

Bleeding from varicose veins of the leg 206 

Beils_ 175 

Bottle feeding of infants_ 90 

Boxed can privy_ 41 

Brain injuries_289 

Break-bone fever (dengue)_139 

Breast pang (angina pectoris)_161 

Bio ken neck or back_258 

Bronchitis_ j-157 

Broncho-pneumonia-159 

Bruise_233 

Bruises with wounds of the skin-234 

Brush burn_t_198 

Bubo, venereal_158 

Bullet wounds-198 

Burns and scalds-269 

Burns from carbolic acid_273 

Burns from chemicals, such as strong 

acids or alkalies-272 

Burns of the eye by chemicals-273 

Camp sanitation------— 68 


Page. 


Camp structures___ 69 

Carbolic acid poisoning_292 

Carbon monoxide_ 22 

Care of the baby_ 87 

Care of the feet- 83 

Care of the mouth and teeth_ 81 

Care of the sick_102 

Carrel-Dakin solution_192 

Catheterizing_157 

Cause of inflamed wounds_181 

Causes of unconsciousness_286 

Chancre_153 

Chicken pox_122 

Childbirth (labor)_ 84 

Cholera (epidemic cholera, Asiatic 

cholera)_141 

Cholera morbus (sporadic cholera)_166 

Chronic nephritis_170 

Chronic rheumatism_117 

Cisterns- 39 

Cleaning_48 

Cleaning of buildings- 48 

Clothing_ 80 

Clothing of infants_ 97 

Coal gas_ 22 

Colds_157 

Cold air_ 25 

Cold baths_103 

Colic_167 

Colic, infantile_ 93 

Compound fractures_267 

Compression of the brain_289 

Concussion-289 

Condensed milk_ 94 

Conjunctivitis_177 

Constipation-165 

Constipation of infants- 93 

Construction of buildings_ 17 

Construction of vessels_ 61 

Consumption (tuberculosis)_129 

Contagious diseases among children_ 99 

Convulsions->--174 

Cook tent_ 69 

Coughs and colds-157 

Covered can privy_ 41 

Crepitus or grating_246 

Croup_158 

Croup kettle-158 

Daily quantity of food- 74 

Daily quantity of water required_ 30 

Delirium tremens_171 

Description of germs-182 

Description of wounds-181 

Diarrhea_160 

Diarrhea of infants_ 93 

Diet- 74 


315 








































































































316 


INDEX 


Page. 


Diet for the sick_ 103 

Diphtheria_113 

Directions for taking temperature_103 

Directions to be followed in case of 

poisoning_293 

Disinfecting solutions_104 

Disinfection of clothing_104 

Disinfection of room_124 

Disinfection of water supplies- 70 

Disinfection of wounds_187 

Dislocations_241 

Dislocation of collar bone or clavicle_248 

Dislocation of the fingers_242 

Dislocation of the lower jaw_242 

Dislocation of the shoulder_242 

Dislocation of the thumb_242 

Disposal of refuse_,_ 48 

Deg bites_202 

Drafts_ 25 

Draw sheet_103 

Dressing and treatment of wounds_189 

Driven wells_ 38 

Dropping medicine in the eye_236 

Drowning_279 

Dust as a cause of disease_ 27 

Dysentery_108 

Dyspepsia_164 

Earache_179 

Effects of alcholic liquor_ 77 

Effects of cold air_ 25 

Effects of cold—frostbite_274 

Effects of heat and cold-269 

Electric burns_273 

Electric light_ 22 

Electric shock-282 

Emetics_292 

Erysipelas (St. Anthony’s fire)-112 

Exercise_ 79 

Fainting_161, 287 

Fatigue_ 80 

Figure-of-eight bandage-233 

Filter bed_ 32 

Fireplaces_!.- 28 

First aid to the injured-181 

First-aid packets-190 

Fish-tail burners_ 23 

Fits_288 

Fleas- 57 

Flies_ 50 

Floor coverings-- 48 

Foot hath_I-103 

Foot candle__ 21 

Foreign bodies in the ear-237 

Foreign bodies in the eye_235 

Foreign bodies in the gullet_237 

Foreign bodies in the larynx_238 

Foreign bodies in the nose_236 

Foreign bodies in the pharynx-237 

Foreign bodies in the throat-237 

Four-tailed bandage-229 

Fractures- — 245 

Fractures of the arm_i— 254 

Fractures of the base of the skull-255 

Fracture of the bones of the hand-251 

Fracture of the bones of the foot_267 

Fracture of the bones of the leg-265 


Pag®. 


Fracture of the collar bone-257 

Fractures around the elbow joint-253 

Fracture of the fingers_251 

Fractures of forearm_252 

Fracture of the knee cap_264 

Fractures of the lower extremities_259 

Fracture of the lower jaw_256 

Fracture of the nose_256 

Fracture of the ribs_257 

Fracture of the skull_255 

Fracture of the thigh bone_260 

Fractures of the toes_267 

Fracture of the wirst_252 

Gallstones_168 

Garbage disposal_ 71 

Gargle_ 128 

Gas poisoning_284 

General rules as to what to do in case 

of accident_298 

German measles_127 

Germicides and antiseptics_186 

General antidote_291 

General directions for aiding the in¬ 
jured _297 

Germs in water_ 30 

Glare_ 23 

Gonorrhea (clap)_154 

Gonorrheal rheumatism_118 

Grades of milk_ 75 

Gravel_168 

Gumboil_ 81 

Headache_174 

Heart disease_160 

Heating_ 28 

Heating of buildings_ 28 

Heat cramps_173 

Heat stroke_172 

Hemorrhage_204 

Hemorrhage into the abdomen_219 

Hemorrhage from the face and fore¬ 
head_215 

Hemorrhage from the lungs_218 

Hemorrhage from the neck_216 

Hemorrhage from the nose_217 

Hemorrhage from the palm of the 

hand_217 

Hemorrhage from piles_218 

Hemorrhage from the scalp_215 

Hemorrhage from the stomach_218 

Hemorrhage from a tooth socket_218 

Hemorrhage from the trunk_217 

Hernia_233 

Heroin, antidote for_294 

History of illness_103 

Home modification of milk_ 91 

Hookworm (Nercator americanus)-150 

Hot-air furnaces_ 29 

Hot-water and steam pipes_ 29 

Hot-water bottles-102 

Hours of labor_ 80 

How to prevent consumption-131 

How to produce sweating-171 

Humidifiers_ 25 

Humidity of the air_ 23 

Hydrophobia, symptoms of-203 

Ice for cooling drinking water_ 64 





























































































































IKDEX 


317 


Page. 


Illuminating gas_ 22 

Impacted fractures_246 

Improvised bandages_230 

Incised wounds_183 

Indigestion_ 164 

Infected wounds_184 

Inflamed leg ulcers_196 

Inflamed wounds_194 

Inflamed wound of the hand_195 

Influenza_112 

Injuries to joints_240 

Insect stings_202 

Instructions for saving drowning per¬ 
sons by swimming to their relief_279 

Intestinal parasites in water_ 30 

Iritis_177 

Isolation in disease_103 

Itch-mite (Scarcoptes scabiei)_ 59 

Kidney disease_170 

Kidney stone_168 

Lacerated wounds_183 

La grippe-112 

Lamps- 21 

Large cuts_191 

Laudanum, antidote for-294 

Lead colic_167 

Lice___ 58 

Lighting_ 20 

Lighting of buildings_ 20 

Lightning shock_282 

List of medical and surgical supplies_312 

List of remedies_307 

Lockjaw-196 

L. R. S. privy_ 41 

Lye, ammonia water, or other strong 

alkalies ; poisoning_294 

Malarial fever_133 

Many-tailed bandage_229 

Measles_123 

Mess tent_ 69 

Method of taking patient’s tempera¬ 
ture _103 

Milk__ 75 

Milk bottles_ 95 

Mixed feeding of infants_ 90 

Model well- 33 

Morphine, antidote for-294 

Mosquitoes- 54 

Mosquito and flea bites~-204 

Mosquitoes on vessels- 64 

Mother’s milk_ 88 

Mumps_128 

Muriatic acid, antidote for-294 

Muscular rheumatism-118 

Mushroom poisoning-297 

Nasal spray-140 

Natural gas- 22 

Natural ventilation- 26 

Neuralgia —*-174 

Nipples- 95 

Nitric acid, antidote for-294 

Nursing-102 

Oozing_206 

Opium, laudanum, morphine, and 

heroin poisoning-294 

Ordinary bleeding---.... 205 


Page. 


Packing a wound to check hemorrhage- 206 

Painter’s colic_167 

Palpitation_161 

Paris green, antidote for_295 

Pasteurization of milk_ 90 

Pellagra__—,- 75 

Perforating wounds of the chest_198 

Permanent splints-248 

Personal hygiene_ 74 

Piles_169 

Plague_2-144 

Plaster of Paris casts_250 

Plasters_232 

Pleurisy_ 160 

Plumbing_ 40 

Pneumonia_110 

Poisons-291 

Poison ivy_175 

Poisoned wounds-200 

Poisoning_291 

Poisoning from illuminating gas- 22 

Pork tapeworm (Tsenia solium)-149 

Pott’s fracture_266 

Prenatal care_101 

Preparation of bed_102 

Preventable blindness_177 

Prevention of disease_ 17 

Privies_ 41 

Proper method of milking_ 76 

Provisional tourniquets-210 

Ptomaine poisoning_296 

Pulse_103 

Punctured wounds_183 

Rabies, symptoms of_203 

Rat guards_ 66 

Rat proofing of buildings- 18 

Rats on vessels_ 64 

Recurrent bandage_225 

Relative humidity_ 23 

Rescue of drowning persons_279 

Respirations_108 

Respirators- 27 

Resuscitation from electric shock-282 

Resuscitation from gas poisoning-285 

Retention of urine-156 

Rheumatic fever-116 

Rheumatism-115 

Riggs’ disease- 81 

Roaches_ 60 

Roller bandage-222 

Roundworm (Ascaris lumbricoides)_149 

Rupture_238 

Sanitation of buildings- 17 

Sanitation of vessels_ 61 

Scalp wounds-199 

Scarlet fever-125 

Schaefer method of artificial respira¬ 
tion _277 

Soreening of buildings- 18 

Scurvy-147 

Seatworm (Oxyuris vermicularis)-150 

Selection of a camp site- 68 

Setting a bone-250 

Setting-up exercises_ 79 

Sewage disposal-39 

Sewing up a wound-198 




























































































































318 


INDEX 


Page. 


Shallow wells_ 34 

Shock_220 

Sick room_108 

Simple fracture_246 

Sleep, Infants’_ 97 

Sleeping outdoors_132 

Sling psychrometer_ 23 

Small cuts_191 

Smallpox_ 118 

Snake bites_200 

Soft chancre (chancroid)_153 

Sore eyes_177 

Sore mouth_162 

Sore throat (tonsillitis, quinsy)_163 

Special poisons_292 

Spiral reversed bandage_223 

Splinters__198 

Spotted fever (cerebrospinal menin¬ 
gitis)_140 

Sprains_240 

Springs_ 39 

Standard for drinking water- 32 

Sterile dressings_185 

Sterilization of the hands_184 

Sterilization of milk_ 91 

Stings of centipedes, tarantulas, and 

scorpions--- 202 

Stoves- 28 

Strained or lame back_234 

Strains-234 

Strangulated hernia-239 

Strangulation and hanging_285 

Stricture of the urethra_156 

Strong acids, such as muriatic acid, ni¬ 
tric acid, or sulphuric acid ; poison¬ 
ing- 294 

Strychnine poisoning-296 

Suffocation-:-276 

Sulphur fumigation_ 65 

Sunburn_269 

Sunstroke_-_172 

Sunstroke and heat exhaustion_ 273, 291 

Suppression of flies___ 72 

Sweeping_ 49 

Symptoms of childbirth- 84 

Symptoms of fracture-246 

Symptoms of wounds-184 

Syphilitic rheumatism-118 


Par*. 

Syphilis_ 151 

T-bandage____230 

Tapeworms_- 147 

Temperature of body-103 

Tetanus_196 

Ticks_ 60 

Tincture of Iodine poisoning_295 

Tourniquets_*-208 

Trachoma_178 

Transmission of disease by insects_ 50 

Transportation of the injured-301 

Treatment of sewage- 89 

Triangular bandage-227 

Tying arteries_213 

Typhoid fever_104 

Typhoid prophylaxis-106 

Typhus fever-107 

Unconsciousness_285 

Vaccination_120 

Vaccination of children_100 

Varieties of fracture_245 

Varieties of wounds_183 

Venous hemorrhage_206 

Venereal warts_155 

Ventilation_ 23 

Ventilation of buildings_ 26 

Ventilation of vessels_ 62 

Vitamines_ 75 

Washing of woolen garments_ 80 

Water for vessels_ 63 

Water carriage system of sewerage_ 39 

Water filters- 32 

Water gas- 22 

Water supply- 30 

Water supply of buildings_ 30 

Water supply for camps_ 70 

Weaning-,- 89 

Weighing the baby_ 98 

Well bucket_ 38 

Welsbach lights_ 23 

White damp- 22 

Whooping cough_127 

Wounds_* 181 

Wounds of the abdomen_199 

Wcunds of the brain_ 290 

Wounds caused by fishhooks_198 

X-rays of fractures_247 

Yellow fever_ 137 


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